Spinal Cord Disorders Overview

Overview of Spinal Cord Disorders

• Spinal cord disorders can cause permanent severe problems, such as paralysis or impaired bladder and bowel control (urinary incontinence and fecal incontinence).
• Quick evaluation and treatment can help avoid or minimize these problems.
• Causes of spinal cord disorders include injuries, infections, a blocked blood supply, and compression by a fractured bone or a tumor.
• Symptoms of spinal cord disorders include weak or paralyzed muscles, abnormal or lost sensation, and difficulty controlling bladder and bowel function.
• Diagnosis is based on symptoms and results of a physical examination and imaging tests, such as magnetic resonance imaging (MRI).
• Treatment involves correcting the underlying condition causing the disorder, and often requires rehabilitation to recover as much function as possible.

Causes of Spinal Cord Disorders

• Outside the spinal cord:
  • Injuries
  • Compression of the spinal cord (e.g., by bone, blood, tumor, or disk)
  • Blockage of the blood supply
• Inside the spinal cord:
  • Fluid-filled cavities (syrinxes)
  • Blockage of the blood supply
  • Inflammation (e.g., acute transverse myelitis)
  • Tumors, abscesses, bleeding (hemorrhage)
  • Vitamin B12 deficiency, copper deficiency
  • Infection with human immunodeficiency virus (HIV), COVID-19, multiple sclerosis, or syphilis
  • Radiation therapy

Cauda Equina Syndrome

• Caused by severe compression of the nerve roots in the lumbar spine, often due to an acute lumbar disc herniation.
• Symptoms include:
  • Low back pain
  • Pain radiating down the leg
  • Numbness around the anus
  • Loss of bowel or bladder control
  • Saddle-like paresthesias (abnormal sensations)
• Diagnosis is made clinically, with urgent MRI to confirm the cause.
• Treatment involves prompt surgical decompression, ideally within 24 hours, or absolutely within 48 hours.

Symptoms of Cauda Equina Syndrome

• Motor:
  • Muscle weakness or paralysis in one or both legs
  • Weakness of the muscles of the lower legs (often paraplegia)
  • Achilles (ankle) reflex absent on both sides
  • Absent superficial reflexes
  • Gait disturbance
• Sensory:
  • Severe low back pain
  • Pain, numbness, or weakness in one or both legs
  • Later hypoesthesia or anaesthesia in affected dermatome
  • Loss or altered sensations in the legs, buttocks, inner thighs, backs of legs, or feet
  • Saddle anaesthesia (numbness or "pins-and-needles" sensations)
• Autonomic:
  • Sphincteric dysfunction
  • Sensory atonic bladder or motor atonic bladder
  • Vasomotor and trophic changes
  • Recent problem with bladder or bowel function (retention or incontinence)
  • Sexual dysfunction

Neurogenic Bladder

• A condition in which problems with the nervous system affect the bladder and urination
• Types:
  • A.UMNL (Upper Motor Neuron Lesion):
    • Acute: retention of urine with overflow
    • Gradual: partial lesion causing precipitancy of micturition or complete lesion causing automatic bladder
  • B.LMNL (Lower Motor Neuron Lesion):
    • Sensory atonic bladder: absence of sense of fullness of bladder, overflow retention of urine
    • Motor atonic bladder: preservation of sense of fullness of bladder, retention of urine with moderate size of bladder, inability to evacuate bladder voluntarily
    • Autonomic or autonomous bladder: incomplete, irregular, and involuntary evacuation of the bladder

Transverse Myelitis

• Definition: An inflammation of both sides of one section of the spinal cord, often damaging the insulating material covering nerve cell fibers (myelin)
• Signs and symptoms:
  • Pain, often beginning suddenly in the lower back, with sharp pain shooting down to the legs or arms
  • Abnormal sensations, such as numbness, tingling, coldness, or burning
  • Weakness in arms or legs, sometimes with severe weakness or total paralysis
  • Bladder and bowel problems, such as urinary incontinence, difficulty urinating, and constipation
• Causes:
  • Viral and other infections, including herpes viruses, which can infect the spinal cord directly
  • Multiple sclerosis
  • Neuromyelitis Optica (Devic's disease)
  • Rarely, parasites or bacteria, such as Lyme disease, can cause a painful inflammation of nerve roots of the spinal cord