Management of Acute Spinal Cord Compression

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

Management

1. General measures: All the general
measures such as care of skin, bowel and bladder, prevention of deep vein thrombosis by leg exercises, psychological support discussed in the management of transverse myelitis are applicable here also.

2. Specific therapy: Nature of specific treatment depends on the underlying cause:

i. Traumatic paraplegia:
• Immobilisation and spinal traction
for vertebral dislocation
• Surgery for spine.
• Urgent surgical decompression
(laminectomy).
• High dose methylprednisone
(30 mg/kg 1.V. bolus, then 5.4 mg/kg/hr for 24 hours) if given within 8 hours of injury improves motor-sensory function in the long run.

ii. Nontraumatic spinal cord compression:
• Appropriate or broad spectrum
antibiotic therapy for pyogenic infec-
tion such as acute epidural abscess.
• Laminectomy with debridement
for decompression of cord. Surgical
evacuation prevents paralysis or
reverse paralysis in evolution.
• ATT for tuberculosis of the spine.
• Vascular surgery (ligation of a
feeding vessel, excision of AVM).

iii. For neoplastic extramedullary spinal cord compression:
• Glucocorticoids are given in higher
doses (dexamethasone 40 mg/day)
to reduce cerebral oedema. The
dose is reduced to 20 mg until radiotherapy is completed.
• Local radiotherapy is initiated as
early as possible. Newer techniques
including intensity-medullated
radiotherapy (IMRT) can deliver
high doses with good response.
• If radiotherapy fails or not tolerated,
then surgery (decompression or
vertebral body compression) is
indicated.

iv. Intradural tumours (meningioma/neurofibroma) require surgical resection.

3. Long term management
• Pain: Pain at or below the level of neurological lesion is common and sometimes distressing. Most patients responds to rehabilitation and treatment with analgesics, antidepressants or anticonvulsants. Transcutaneous nerve stimulation, acupuncture, hypnotherapy and the relaxation exercises may help.
Surgical interruption of pain fibres or
tract is unnecessary and not recommended.
• Spasticity: It is treated by regular physiotherapy. It can be relieved by baclofen or dantrolene and in resistant cases by motor point injections, local nerve block and neurectomy.
• Sexual function: In men who cannot otherwise attain erection of penis sufficient for intercourse, intracavernous papaverine, vacuum erection aids and rarely penile implants are useful. In women fertility remains normal,
therefore assisted conception technique including seminal fluid enhancement, intrauterine insemination or in vitro fertilisation have improved the likelihood of fathering children.