Spinal Cord And Root Compression Investigations

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MYELOGRAPHY

If MRI is unavailable, myelography is used to screen the spinal cord and the cauda equina. This will identify the level of a compressive lesion and indicate its probable site i.e. intradural, extradural.

PARTIAL BLOCK

Extradural

COMPLETE BLOCK

Dura lifted off vertebral body

'Ragged' edge to contrast material at site of block

Intradural

EXTRAMEDULLARY BLOCK

Cord displaced to one side

INTRAMEDULLARY BLOCK

Cord displaced to one side

'Shoulder' of contrast material

Contrast material is splayed around the dilated cord

Vertebral body eroded by tumour

Even with an apparent 'complete' block, sufficient contrast medium may be 'coaxed' beyond the lesion to determine its upper extent. If not, a cervical puncture may be necessary.

Radio-opaque markers on the skin surface at the site of the block are a useful operative guide. Lesions in the lumbar and sacral regions require a 'radiculogram', outlining the lumbosacral roots.

CT SCAN/CT MYELOGRAPHY

It is impractical to use this as a screening investigation for cord compression, but if the level of interest is known, CT scanning provides useful additional information.

Plain CT with axial cuts will clearly demonstrate bone erosion, osteophytic outgrowth and thickened facet joints causing narrowing of the spinal canal or intervertebral foramen. Axial cuts will also demonstrate disc disease of the lumbosacral spine, show the relationship of any paraspinal mass to the vertebral body and intervertebral foramen and identify the extraspinal extent of an intraspinal lesion, e.g. neurofibroma.

CT myelography with axial cuts (CT performed either 6-12 hours after routine myelography or immediately after intrathecal injection of just a few mis of contrast) demonstrates clearly the degree of spinal cord or nerve root compression.

Displaced thecal sac containing contrast medium

Neurofibroma

CSF ANALYSIS

This is of limited value in cord compression. Abnormalities frequently occur, but lumbar puncture may precipitate neurological deterioration, presumably due to the creation of a pressure gradient.

If cord compression is suspect rhen lumbar puncture and CSF analysis should await imaging.

CSF protein: often increased, especially below a complete block.

CSF cell count: a marked leucocyte count suggests an infective cause - abscess or tuberculosis. CSF cytology may reveal tumour cells

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