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 sex
- 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
Investigations to consider
- full blood count with differential
- erythrocyte sedimentation rate and C-reactive protein
- blood or cerebrospinal fluid cultures
- tumour biopsy and histopathology
- urodynamic studies
- positive emission tomography (PET) scan of the spine
Treatment algorithm
Contributors
Authors VIEW ALL
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 several references cited in this topic.
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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