Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • age group 16 to 30 years (trauma)
  • age group 30 to 50 years (disc disease)
  • age group 40 to 75 years (malignancy)
  • acute onset and duration of symptoms
  • chronic onset and duration of symptoms
  • back pain
  • numbness or paraesthesias
  • weakness or paralysis
  • bladder or bowel dysfunction
  • hyper-reflexia
  • sensory loss
  • muscle weakness or wasting
  • loss of tone below level of suspected injury (spinal shock)
  • hypotension and bradycardia (neurogenic shock)
  • complete cord transection syndrome
  • cauda equina syndrome
  • central cord syndrome

Other diagnostic factors

  • history of malignancy
  • immunosuppression
  • intravenous drug use
  • loss of rectal sphincter reflex
  • loss of appendicular reflexes
  • local deformity of spine on palpation
  • Brown-Sequard's syndrome
  • anterior cord syndrome
  • posterior cord syndrome

Risk factors

  • age between 16 and 30 years and male gender
  • trauma
  • tumour
  • osteoporosis
  • high-risk occupation
  • high-risk recreational activities
  • intravenous drug use
  • immunosuppression

Diagnostic investigations

1st investigations to order

  • MRI spine
  • gadolinium-enhanced MRI spine
  • plain spine x-ray
  • CT spine
  • CT myelography
Full details

Investigations to consider

  • FBC with differential
  • ESR and C-reactive protein (CRP)
  • blood or CSF cultures
  • tumour biopsy and histopathology
  • urodynamic studies
  • positive emission tomography (PET) scan of the spine
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Kenneth F. Casey

Clinical Associate Professor Surgery (Neurosurgery)

Michigan State University

Clinical Associate Professor (Physical Medicine and Rehabilitation)

Wayne State University School of Medicine

Detroit

MI

Disclosures

KFC declares that he has no competing interests.

Peer reviewers VIEW ALL

Professor of Neurology

Moffitt Cancer Center and Research Institute

University of Washington

Seattle

WA

Disclosures

MC is an author of a reference cited in this monograph.

Interventional Spine Physiatrist

Pain Medicine Specialist

Medical Director

Spine Center

Lahey Clinic

Burlington

MA

Disclosures

AGC declares that he has no competing interests.

Chief and Professor of Medicine

Division of Infectious Diseases and International Health

University of Virginia Health System

Charlottesville

VA

Disclosures

WAP declares that he has no competing interests.

Professor and Chief Physician

Orthopaedic Department

Clinic of the General Hospital of CPLA

Beijing

China

Disclosures

SH declares that he has no competing interests.

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