Chapter 9 - Spinal cord disease in the hospitalized patient

Summary

Acute and subacute spinal cord disorders are an important area of hospital medicine given the high risk of devastating neurological complications. This chapter presents the clinical characteristics, diagnosis, differential diagnosis, treatment and prognosis of the following spinal disorders: spinal epidural abscess, transverse myelitis, cauda equina syndrome, spinal cord injury, vascular myelopathies, and neoplastic disorders. Spinal cord trauma can be acutely life-threatening or result in severe chronic disability. Appropriate initial management is crucial to maximizing eventual neurological function. Like cerebral stroke, vascular myelopathy is considered when myelopathic deficits develop abruptly. Spinal epidural abscess results from hematogenous seeding of infection either directly into the epidural space, or to the vertebral body or intervertebral disk with subsequent spread into the epidural space. Cauda equina syndrome (CES) is most commonly due to anatomical compression from a large central disc. Metastases are the most common type of tumor affecting the spine.