There may be loss of autonomic activity with lack of sweating below the level, loss of thermoregulation and drop in peripheral resistance causing hypotension.Sphincter disturbances - late features of cervical and thoracic cord and/or compression.Normal above the level of injury and/or compression.Absent at the level of injury and/or compression.Increased below the level of injury and/or compression.Light touch, proprioception and joint position sense are reduced. Sensory symptoms can include sensory loss and paraesthesia.Lumbar spine lesions can affect L4, L5 and sacral nerve roots.Thoracic spine lesions produce paraplegia.Injury above the level of C3, C4, C5 (the segmental level of the phrenic nerve) cause paralysis of the diaphragm and artificial ventilation is required. Cervical spine lesions can produce quadriplegia.Motor symptoms can include ready fatigue and disturbance of gait.Clinical features depend upon the extent and rate of development of spinal cord compression. The latter can lead to neurogenic shock, paralytic ileus, aspiration, urinary retention, priapism and loss of thermoregulation. Motor, sensory and autonomic dysfunction can occur. Sensory changes are variable, with loss of vibration and joint position sense more evident in the hands than in the feet.Lower motor neurone signs in the upper limbs (atrophy, hyporeflexia).Upper motor neurone signs in the lower limbs (Babinski's sign: up-going plantar reflex, hyperreflexia, clonus, spasticity).Lhermitte's sign: flexion of the neck causes an electric shock-type sensation that radiates down the spine and into the limbs.Neurological symptoms: gait disturbance, clumsy or weak hands, or loss of sexual, bladder, or bowel function.

Red flags that suggest spinal compression include: Red flagsSee also the separate Neck Pain (Cervicalgia) and Torticollis and Low Back Pain and Sciatica articles. Damage to the spinal cord may be a very rare complication of chiropractic or osteopathic manipulation of the neck.In advanced stages, it can cause spinal cord compression.The ageing process can lead to narrowing of the spinal canal due to osteophytes, herniated discs and ligamentum flavum hypertrophy.Vertebral osteomyelitis, discitis or haematogenous spread of infection can lead to an epidural abscess.Acute infections are usually bacterial chronic infections are usually due to tuberculosis or fungal infection.Spinal infections can be acute or chronic.If this ruptures, the atlas can slip forward on the axis and compress the high cervical spine. In rheumatoid arthritis there is often considerable weakness of the ligament that holds the odontoid peg.Inflammatory disease, especially rheumatoid arthritis:.There may be a history of trauma, a recent spinal procedure and/or the patient may be on anticoagulant therapy.Cervical disc herniation can also occur.See the separate Cauda Equina Syndrome article which discusses it in more detail. Large disc herniations can cause cauda equina syndrome. L4-L5 and L5-S1 are the most common levels for disc prolapse.Acute myelopathy in patients with cancer can also be caused by irradiation, paraneoplastic necrotising myelitis, ruptured intervertebral disc and meningeal carcinomatosis with spinal cord involvement.These can include bone tumours, primary or metastatic tumours, lymphomas, multiple myeloma and neurofibromata.Spinal tumours, both benign or malignant:.It is usually caused by a penetrating trauma. Hemisection of the spinal cord can occur and is known as Brown-Séquard's syndrome.Complete transection of the spinal cord can occur.There is usually either vertebral fracture (most common in cervical vertebrae) or facet joint dislocation.Trauma (including car accidents, falls and sports injuries):.Rapid diagnosis and management of spinal cord compression are essential to have the highest chances of preventing permanent loss of function. See also the separate Whiplash and Cervical Spine Injury article.Īcute spinal cord compression is a neurosurgical emergency.

Cervical spine compression