Spinal Cord Lesions

Definition

Spinal cord lesions refer to damage to the spinal cord that can result from trauma, disease, or other conditions, leading to a range of neurological deficits depending on the location and severity of the lesion. These lesions can disrupt the transmission of nerve signals between the brain and the rest of the body.

Aetiology

Spinal cord lesions can be caused by various factors, including:

Traumatic injury (e.g., motor vehicle accidents, falls, sports injuries)
Infections (e.g., spinal epidural abscess, myelitis)
Tumours (e.g., primary spinal cord tumours, metastatic cancer)
Degenerative diseases (e.g., multiple sclerosis, amyotrophic lateral sclerosis)
Vascular disorders (e.g., spinal cord infarction, arteriovenous malformations)
Inflammatory conditions (e.g., transverse myelitis)

Pathophysiology

The pathophysiology of spinal cord lesions depends on the underlying cause but generally involves disruption of the neural pathways within the spinal cord. This can lead to loss of motor, sensory, and autonomic function below the level of the lesion. Mechanisms of damage include direct trauma, ischemia, inflammation, and compression.

Risk Factors

Participation in high-risk activities (e.g., contact sports, extreme sports)
Pre-existing spinal conditions (e.g., spinal stenosis, osteoarthritis)
Infections that affect the central nervous system
Cancer with potential for spinal metastasis
Chronic inflammatory or autoimmune diseases

Signs and Symptoms

Loss of motor function or paralysis below the level of the lesion
Loss of sensation, including touch, pain, and temperature
Autonomic dysfunction (e.g., loss of bladder and bowel control, changes in blood pressure)
Muscle spasms or spasticity
Severe pain or abnormal sensations (e.g., tingling, burning)

Investigations

Clinical history and physical examination, including neurological assessment
Magnetic Resonance Imaging (MRI) of the spinal cord to identify lesions
Computed Tomography (CT) scan if MRI is contraindicated or unavailable
Electromyography (EMG) and nerve conduction studies to assess nerve function
Blood tests to identify underlying conditions (e.g., infections, inflammatory markers)
Lumbar puncture to analyze cerebrospinal fluid (CSF) in cases of suspected infection or inflammation

Management

Primary Care Management

Initial assessment and stabilisation, especially in traumatic cases
Immediate referral to a neurologist for further evaluation and management
Supportive care, including pain management and monitoring of vital functions

Specialist Management

Surgical intervention for decompression, stabilisation, or removal of tumours or abscesses
Medical management of underlying conditions (e.g., antibiotics for infections, steroids for inflammation)
Rehabilitation involving physical therapy to maintain muscle strength and improve mobility
Occupational therapy to assist with daily activities and adaptive equipment
Psychological support and counselling for patients and families
Long-term follow-up to monitor recovery and manage complications

Example Management for Spinal Cord Lesions

A patient presenting with sudden onset of paralysis and sensory loss following a motor vehicle accident should be stabilised and referred to a specialist immediately. An MRI should be performed to identify the location and extent of the spinal cord injury. Surgical decompression may be necessary if there is significant compression of the spinal cord. Post-operative care includes pain management, physical therapy to maintain muscle strength, and occupational therapy to help the patient adapt to daily activities. Regular follow-up is essential to monitor recovery and manage any long-term complications.

References

NICE. (2024). Spinal Injury: Assessment and Initial Management. Retrieved from NICE
NHS. (2023). Spinal Cord Injury. Retrieved from NHS
Fehlings, M. G., et al. (2017). A Clinical Practice Guideline for the Management of Acute Spinal Cord Injury. The Lancet.
Hickey, K. J., et al. (2011). Early Decompression and Neurological Outcome After Traumatic Cervical Spinal Cord Injury. Spine.
Kalb, R., et al. (2010). Management of Nontraumatic Spinal Cord Lesions. Neurology.