Last reviewed: November 2017
Last updated: July  2016

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • back pain
  • bruising
  • acute numbness/paraesthesia
  • weakness
  • spinal deformity
  • muscle spasticity/clonus (hypertonicity) or hypotonia
  • hyperreflexia or hyporeflexia
  • Hoffman's sign
  • positive Babinski's sign
  • loss of anal sphincter reflex

Other diagnostic factors

  • absence of bulbocavernosus reflex (S3-S4)
  • signs of spinal shock (hypotonia or flaccidity that resolves within 24 hours)
  • urinary incontinence
  • painless urinary retention

Risk factors

  • male sex
  • age >65 years
  • concomitant osteoporosis
  • previous vertebral fracture
  • underlying neoplastic lesion
  • underlying metabolic or inflammatory disorders
  • falling from a height
  • motor vehicle accident

Diagnostic investigations

1st investigations to order

  • thoracolumbar spine x-ray (anterior-posterior and lateral views)
Full details

Investigations to consider

  • CT spine
  • MRI spine
  • CT myelography
  • MRI with STIR sequence
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Specialty Registrar

Emergency Medicine

St Thomas’ Hospital

London

UK

Disclosures

BN declares that he has no competing interests.

David Choi

Consultant Neurosurgeon and Spinal Surgeon

The National Hospital for Neurology and Neurosurgery

London

UK

Disclosures

DC declares that he has no competing interests.

Peer reviewers VIEW ALL

Associate Professor

Department of Orthopedic Surgery and Rehabilitation

Division of Plastic and Reconstructive Surgery

University of Nebraska Medical Center

Omaha

NE

Disclosures

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

Professor of Surgery

Division of Neurosurgery

University of Toronto

Physician

Department of Otolaryngology

Sunnybrook Health Sciences Centre

Toronto

Canada

Disclosures

DWR declares that he has no competing interests.

Professor

Division of Neurosurgery

Dalhousie University & QEII Health Sciences Centre

Halifax

Canada

Disclosures

RH declares that he has no competing interests.

Department of Neurological Surgery

Weill Cornell Medical College

New York-Presbyterian Hospital

New York

NY

Disclosures

AT declares that he has no competing interests.

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