Compression from: spinal stenosis, OA/degenerative disease, disc herniation, ligamentous hypertrophy, tumor (metastatic), infection (epidural abscess), or contributions from multiple processes
Inflammation from idiopathic/autoimmune processes (e.g. transverse myelitis)
Nutritional deficiencies, in particular: B12 and copper
Vascular malformations (e.g. AVMs within the dura or cord)
Primary tumors of the spinal cord (unusual)
Vascular insufficiency affecting the cord (e.g. interruption of artery of Adamkiewicz post AAA repair, embolic phenomenon)
Syringomyelia: fluid filled cavity occurring within the cord
Unusual infections: HIV, HTLV 1
Risk Factors
Degenerative compression occurs most commonly in older patients; can also occur related to trauma, disc disruption, RA, other
For nutrition related: sometimes idiopathic, poor diets, or post gastric surgery
HIV RFs for HIV related; Caribbean, Central/South America, Japan for HTLV1
Symptoms
Symptoms are based on level (cervical, thoracic, lumbro-sacral), region of cord affected/compressed (e.g. anterior, lateral, dorsal), whether from external or internal causes; or related to other processes if non-compressive; Rate of progression related to specifics of underlying process
Cervical: progressive bilateral weakness, numbness, hand clumsiness, neck pain; leg weakness and gait disturbance sometimes occurs before arms/hands (lateral cortico-spinal tracts to legs are on outside of cord relative to those traveling arms/hands), urinary and/or bowel symptoms often occur late
Thoracic Level: Upper extremities spared; lower extremity motor and sensory; bowel/bladder symptoms
Spinothalamics travel up contralateral side of cord from the region innervated; Dorsal columns travel up ipsilateral side