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12th August 2024
Overview of spinal cord disorders
The diseases of the spinal cord are a diverse group that can be divided by aetiology:
| Degenerative | Degeneration of the discs or vertebra (spondylosis) leads to pain and stiffness and can cause neurological symptoms by causing compression of the cord (myelopathies), the cauda equina, or exiting nerve roots (radiculopathies). |
| Inflammatory | Spinal inflammatory diseases include transverse myelitis, neurosarcoid and paraneoplastic syndromes. |
| Infectious | Infections of the spine include epidural abscesses, viral myelitis, tabes dorsalis (tertiary syphilis), Potts’s disease (tuberculous vertebral body destruction) and schistosomiasis. |
| Vascular | Thrombotic or haemorrhagic disease of the vasculature supplying the spine is less common than intracerebrally but can be devastating when it occurs. Arterio-venous malformations may also develop in the spine causing myelo- or radiculopathic symptoms. |
| Malignant | Extramedullary, or more rarely intramedullary, tumour growth (most often metastatic) may lead to compressive symptoms, pain or structural compromise. |
| Toxic or metabolic | Includes subacute combined degeneration of the cord, radiation exposure, intrathecal chemotherapy, electrical injury, hepatic dysfunction, and decompression sickness after diving. |
| Other | Syringomyelia. Ossification of the posterior longitudinal ligament. Pannus formation in rheumatological disease. |
Terminology for spinal cord disorders
Neurological presentations of spinal disease include myelopathies (disruption of the spinal cord) and radiculopathies (disruption of an exiting nerve root). The former leads to loss of function below the level of the lesion with upper motor neuron symptoms. LMN symptoms may be seen around the level of the lesion. Radiculopathies cause symptoms confined to the dermatome/myotome supplied by that nerve. Many of the disorders in the table above can lead to either pathology, for example spinal tumours may cause radiculopathic or myelopathic symptoms depending on location. Finally, inflammation of the spinal cord is termed myelitis.
Anatomy
Image Source: Wikimedia Commons (1962). index.php?curid=30017222, Licensed under a creative commons licence. Available for free at: https://commons.wikimedia.org/w/index.php?curid=30017222 (Accessed: 17 January 2024).
Upper limb: movements, nerves and roots
| Movement | Nerve | Root(s) |
|---|---|---|
| Shoulder Abduction | Axillary | C5 |
| Elbow Flexion | Musculocutaneous | C5,6 |
| Elbow Extension | Radial | C7,8 |
| Wrist Flexion | Median, some ulnar | C6,7 |
| Wrist Extension | Radial | C7,8 |
| Finger Flexion | Median, Ulnar | C8, T1 |
| Finger Extensors | Posterior Interosseous (Radial branch) | C7,8 |
| Finger AB/ADduction | Ulnar | T1 |
Lower limb: movements, nerves and roots
| Movement | Nerve | Root(s) |
|---|---|---|
| Hip Flexion | Femoral | L1,2 |
| Hip Extension | Inferior gluteal | L5, S1 |
| Knee Flexion | Sciatic | L5, S1 |
| Knee Extension | Femoral | L3,4 |
| Ankle Dorsiflexion | Peroneal | L5, S1 |
| Ankle Plantarflexion | Tibial | S1,2 |
| Ankle Eversion | Peroneal | L5, S1 |
| Ankle Inversion | Tibial | L4,5 |
| Hallux Extension | Peroneal | L5, S1 |
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