Spinal cord and root compression

Level of the lesion: a lesion above the LI vertebral body may damage both the cord and its roots. Below this, only roots are damaged.

Vascular involvement: whether neuronal damage results from mechanical stretching or is secondary to arterial ischaemia or venous obstruction remains uncertain. On occasions, clinical findings indicate cord damage well beyond the level of the compressive lesion; this implies a distant ischaemic effect due to blood vessel compression at the lesion site.

Speed of onset: speed of compression affects the clinical picture. Despite producing upper motor neuron damage, a rapidly progressive cord lesion often produces a 'flaccid paralysis' with loss of reflexes and absent plantar responses. This state is akin to 'spinal shock' seen following trauma. Several days or weeks may elapse before tone returns accompanied by the expected 'upper motor neuron' signs.

Intervertebral foramina

Cervical segments

Thoracic segments

Lumbar segments

Sacral segments

Coccygeal segment

(After BING A. Local Diagnosis in Neurological Disease 15 ed.)

Intervertebral foramina

Cervical segments

Thoracic segments

Lumbar segments

Sacral segments

Coccygeal segment

(After BING A. Local Diagnosis in Neurological Disease 15 ed.)

Coccygeal root

Clinical features

These depend on the site and level of the compressive lesion.

PAIN

PAIN

_____root - severe, sharp, shooting, burning pain radiating into the cutaneous distribution or muscle group supplied by the root; aggravated by movement, straining or coughing.

segmental - continuous, deep aching pain radiating into whole leg or one half of body; not affected by movement.

bone - continuous, dull pain and tenderness over the affected area; may or may not be aggravated by movement.

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