Spinal cord and root compression neurological effects

LOWER CORD (CONUS) CAUDA EQUINA LESIONS

Root or segmental lesions may involve the upper part of the cauda equina and produce root/segmental and long tract signs as described on the previous page, e.g. an expanding proximal L4 root lesion causes weakness and wasting of the foot dorsiflexors, sensory deficit over the inner calf, an increased ankle jerk and an extensor plantar response. Bladder involvement tends to occur late.

The lower sacral roots are involved early, producing loss of motor and sensory bladder control with detrusor paralysis. Overflow incontinence ensues. Impotence and faecal incontinence may be noted. A l.m.n. weakness is found in the muscles supplied by the sacral roots (foot plantarflexors and evertors), the ankle jerks are absent or impaired and a sensory deficit occurs over the 'saddle' area.

S3-S5

'Saddle' area.

VERTEBRAL COLUMN

If a spinal cord or root lesion is suspected look for:

- Scoliosis, loss of lordosis or limitation of straight leg raising

- Paravertebral swelling

- Tenderness on bone percussion

- Restricted spinal mobility

- Sacral dimple or tuft of hair

- suggests root irritation

- suggests malignant disease or infection

- suggests bone, disc or root involvement

- suggests spina bifida occulta/dermoid.

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