- Compression from: spinal stenosis from OA/degenerative disease, disc herniation, ligamentous hypertrophy, vertebral subluxation, tumor (metastatic), congenital narrowing, 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
- 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
- Gait problems/imbalance
- Weakness & numbness of lower extremities, typically bilateral
- Urinary and/or bowel incontinence occur late
- Spinothalamics travel up contralateral side of cord from the region innervated; Dorsal columns travel up ipsilateral side
- Symmetric spasticity, hyperreflexia, babinski, impaired sensation (Spinothalamics: pain and temperature; Dorsal columns: roprioception, vibration, pressure)
- May be able to detect sensory level at site of involvement (e.g. numbness below umbilicus w/T-10 level lesion
- Gait disturbance: instability, leg stiffness, wide based
- Decreased rectal tone, elevated post-void residual w/advanced disease
- MRI typically done to confirm site, extent of problem, and underlying process