Next Lesson - Conditions of the Shoulder and Clavicle
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Want more information on anatomy before you begin looking at conditions? Head to our article on The Spine for more information!
Thoracic cord compression is commonly caused by vertebral fractures and tumours. Thoracic cord compression can cause back pain, leg weakness or stiffness, a sensory level on the trunk with altered sensation below it, and bladder or bowel dysfunction. If the compression is around T5, there may also be reduced chest expansion on inspiration.
Diagnostic tests may involve spinal X-ray, CT or MRI scans. Thoracic spinal cord compression requires urgent assessment. Definitive management often involves surgical decompression, with analgesia and supportive measures used as adjuncts depending on the cause.
Cervical myelopathy is the narrowing of the cervical spinal canal causing spinal cord compression. Causes include spondylosis, spondylolisthesis, congenital stenosis of the spinal canal, trauma or a tumour. It classically presents with a loss of balance, poor coordination, decreased dexterity and limb weakness/numbness. It can cause L’Hermitte’s phenomenon - intermittent ‘electrical shocks’ in the limbs exacerbated by neck flexion.
Cervical myelopathy is diagnosed with a thorough neurological examination and an MRI scan. As spondylosis/spondylolisthesis are the most common causes, treatment is usually surgical intervention. A conservative approach may provide short term symptom relief, but as the condition is degenerative it often progresses over time, particularly without surgical intervention.
Diagram - An MRI scan of cervical myelopathy
Creative commons source by Filippo Adamo [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)]
Whiplash is a forceful hyperextension and hyperflexion injury of the cervical spine with associated ligament damage. It is commonly caused by a rapid deceleration for example in a car crash. It presents with neck pain and can cause spinal cord injury, shoulder pain and lower back pain additionally. Whiplash usually self-resolves. In uncomplicated cases, patients are advised to keep the neck mobile, continue with normal activities and use over the counter painkillers once serious injury has been excluded.
Diagram - The pathophysiology behind whiplash injury
Creative commons source by BruceBlaus [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)]
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