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Thoracic cord compression is commonly caused by vertebral fractures and tumours. It presents with pain in the thoracic spine, spastic paralysis of the lower limb muscles, paraesthesia of dermatomes distal to the site of compression and loss of sphincter control. 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)]
A ‘Hangman’s fracture’ is a fracture through the pars interarticulares of the axis (C2 vertebra). It is usually caused by forcible hyperextension of the neck, classically caused through hanging. It is very unlikely to damage the spinal cord because the fracture itself expands the spinal canal, so it typically presents with neck pain alone.
Diagnosis is confirmed with an X-ray or sometimes a CT scan. Treatment can range from a neck brace to neck immobilisation (a form of skeletal traction) to surgical intervention.
Diagram - An X-ray of a Hangman's fracture with the first 4 cervical vertebrae highlighted
Creative commons source by Lucien Monfils, edited by Dr. Thomas Burnell [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)]
A ‘Jefferson’s fracture’ is a fracture of the atlas (C1 vertebra) caused by axial loading e.g. diving into a shallow pool. It presents with upper neck pain but no neurological symptoms. Diagnosis is confirmed with an X-ray or sometimes a CT scan. Treatment can range from a neck brace to neck immobilisation (a form of skeletal traction) to surgical intervention (especially if the transverse ligament is damaged).
Reviewed by: Dr. Thomas Burnell
Edited by: Dr. Maddie Swannack
In this article
The conditions of the back and neck included in this article are: Thoracic cord compression Cervical myelopathy Whiplash Hangman’s fracture Jefferson’s…
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