12th August 2024

Spinal metabolic disease

Subacute combined degeneration of the cord and copper deficiency myelopathy

Vitamin B12 deficiency leads to degeneration of the dorsal and lateral tracts of the cord in SCD. Symptoms include numbness and paraesthesias, weakness, ataxia and gait disturbance. Untreated, it may progress to spasticity and paraplegia. Risk factors include dietary deficiency, pernicious anaemia, drugs (alcohol, nitrous oxide, metformin, PPIs, H2 receptor antagonists), IBD (inflammatory bowel disease), coeliac disease, and gastric/small bowel resection.

Copper deficiency myelopathy presents similarly to SCD.

Radiation myelopathy and chemotherapy

Radiation myelopathy primarily affects the lateral tracts.

Some chemotherapy agents can also induce a myelopathy, especially when given intrathecally, e.g. methotrexate.