Narayana Health Care

Your eagerness to know about spinal cord compression is justified, but for that, we will have to understand a little about our spinal cord. A human spinal cord is the central soft nerve controlling part covered under thick bony vertebrae. This, of course, is for protection perspective as injury to the spinal cord can result in paralysis for life. There are 24 vertebrae in total divided based on the area they support viz cervical, thoracic, lumbar, sacrum, and coccyx. Now between any two vertebras, there lays a small cushion called a disc. At disc level, the spinal cord progresses nerve roots that supply to the whole body enforcing sensation and motor activity.

Once we are aware of the anatomy of the spinal cord, let’s proceed to spinal cord compression. In such a closed space spinal cord is prone to:

• Injuries due to trauma
• Degenerative bone diseases like spondylolysis causing spinal cord or nerve root compression
• Degenerative disc pathologies
• Abnormal spine alignment like in scoliosis
• Aging
• Tumor
• Infection like meningitis
• Rheumatoid Arthritis

As stated above the symptoms of the disease will appear in the region it is supplying:

1. Tingling
2. Numbness
3. Weakness
4. Thinning/ Atrophy
5. Even paralysis
6. Stiffness in back
7. Burning pain
8. Cramping
9. Loss of sensation
10. Incoordination
11. Loss of sexual ability
12. Foot drop (weakness and dropping of foot producing a limp)

These symptoms may appear immediately or gradually depending upon their cause. Sometimes the end of the spinal cord is compressed, causing CAUDA EQUINA syndrome a medical emergency resulting in:

• Losing bowel and bladder control
• Pain and extreme weakness in either or both legs making even getting up very difficult
• Numbness in the inner part of thigh and leg

Diagnosis:

• Verbal questioning -asking for symptoms
• Physical examination for

1. Loss of sensation
2. Weakness
3. Reflex testing for the level of abnormality

• X-ray- for ruling out alignment disorders or see bone growths or osteophytes
• CT / MRI if required to confirm the diagnosis
• Bone scan
• Myelogram after injecting dye in the spinal column
• An electromyograph to test muscle activity testing
• Nerve conduction velocity for nerve sensation testing

Treatment:

A large team of doctors caters to a spinal cord compression

• Neurologist and neurosurgeons
• Orthopaedician
• Physiotherapist
• Rheumatologist

The treatment usually depends on the cause, level, and extent of spinal compression.

• Medical Management: NSAIDs, steroid injections for relieving pain, and to save nerve cells until the further course of action is decided and administered.
• Radiotherapy to address tumor
• Physical Therapy to strengthen back, leg or hand muscles
• Ergonomic and postural advice
• Braces and collars for support
• Acupuncture and chiropractic treatments
• Surgical Treatment: A lot of surgeries as needed are used to treat spinal compression. Let’s look closely.

1. Fusion: The degenerated vertebrae are fused with a bone graft. It is an ancient form of surgery that stops the disease from progressing but limits the spinal movement. Therefore this surgery is no more recommended.
2. Disc Replacement: As other replacements, one or many degenerated discs are removed and replaced by artificial discs that are almost the same in function as the natural disc.

Disc Replacement VS. Fusion	DISC REPLACEMENT	FUSION
Time taken for Recovery	1 week or less	4-6 weeks
Range of Motion	Comparable to the natural spine	Complete loss of motion
Overall Clinical Success	Higher (86.3%)3	Lower (70%)3
Pain post Surgically	Less painful	More painful
Non-Union of fusion	No fusion	Possible
Readmission	Less common	More common

3. Laminoplasty: In this, the vertebra is expanded open and reconstructed after the pressure on the spine is released.
4. Lumbar Stabilization: A flexible and strong titanium device is inserted between vertebras that relieve pain and provide support along with preserving movement.
5. Microsurgery: A small portion of the impaired vertebra, ligament, or disc can be removed through this minimally invasive technique thus relieving the pressure and preserving movement. This surgery requires an incision of 1 inch or lessor.

New Treatment procedures are being discovered every day in this field that is minimally harmful and maximally effective. We will make sure to bring to your notice once proven so.

Dr. Rajesh Verma, Director & Senior Consultant – Orthopaedics, Spine Surgery, Dharamshila Narayana Superspeciality Hospital, Delhi & Narayana Superspeciality Hospital, Gurugram