Assessment

Assume cord compression in any patient with back pain

Always ask about progression/duration of symptoms

Ask about bandlike sensation around trunk

Ask about perianal anesthesia, constipation, diarrhea, or fecal/urinary incontinence/retention

PMH - hx back pain, trauma, known cancer, infection, HIV, immunosuppression

Important social hx - Drug use (esp IV past/present)

Vitals (resp distress/autonomic instability)

Note symmetry of involvement and lack of facial involvement

• Just to keep in mind: A perisagittal mass lesion such as a falx meningioma may produce bilateral leg weakness and urinary incontinence, mimicking a spinal cord lesion.

Motor: bilateral weakness with some degree of symmetry

• If there is bilateral weakness in upper and lower extremities, suggesting cervical involvement, there should be upper motor neuron signs in the legs

• If spinal injury is acute, muscle tone may be decreased below the level of the injury

Reflexes: Hyperreflexia (hypo w/ spinal shock), hoffman’s, crossed adductors, clonus, toes up

Sensory: Check level; See page 95 for Dermatomes

Gait: Can the patient stand/walk?

Percuss spine for tenderness: Tenderness to percussion suggests bony disease and helps localize the lesion.

Rectal: check tone, perianal anesthesia

Immobilize neck if unstable or trauma

Neurosurgery consult

Start steroids w/ likely cord compression without delay (avoid if suspect infection)

• Dexamethasone 10mg, then 4 Q6H IV (tumor)

MRI stat