Diagnosis of Acute Spinal Cord Compression

In this article, we will discuss the Diagnosis of Acute Spinal Cord Compression. So, let’s get started.

Investigations

The purpose of investigations is to establish the site and the nature of the lesion. These are:

  1. TLC and DLC for infective lesion: The ESR is raised in infective pathology especially tuberculosis
  2. X-ray chest: It is done to rule out tuberculosis or bronchogenic carcinoma in patients suspected with Pott’s disease or metastases
  3. X-ray spine (AP and lateral): X-rays of spine (cervical, thoracic, lumbosacral) are done to find out the vertebral fracture/collapse in patients with injury, disc prolapse (in old patients), bony erosions (seen in metastases) or evidence of tubercular osteitis
  4. MRI spine: It is a special tool to differentiate compressive from noncompressive myelopathy, defines the spinal lesion clearly and helps to plan emergency treatment if needed. It has replaced CT and myelography in the diagnosis of spinal cord masses and can differentiate malignant lesions from other masses
  5. CT myelography: It localises the lesion, helps to differentiate extramedullary and intramedullary compression and defines the extent of compression. It has been superseded by MRI
  6. CSF examination: The CSF should not be done except at the time of myelography. In cases of complete spinal block, CSF shows a normal cell count with a markedly elevated proteins producing yellowish discoloration of the fluid (Froin’s syndrome). Acute deterioration may develop after myelography for which it is essential to alert the neurosurgeon in advance
  7. Needle biopsy of the tumor may be required before radiotherapy to establish the histological diagnosis.
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