As the name suggests, the paper will be about spinal cord depression. But how come do we call it a depression? The better word should have been spinal cord compression. Any defect in the spinal cord will lead to depression or not can be explained only after the disease has been manifested fully. The paper will discuss only, the condition affecting the spinal cord (Spinal Cord Depression) along with its causes, manifestations, diagnostic tests and treatments.
Etiology
Spinal cord depression occurs due to any injury that results in putting up excessive pressure on the spinal cord. As a result of such compression, the normal functioning of the spinal cord can get hampered. The depression can develop at any point of the spine starting from the cervical part to the lumbar region.
One of the commonest causes of spinal cord depression is the gradual wear and tear of the spine resulting from advancing age, known as osteoarthritis. This disease condition is very common in the people above the age group of forty to fifty years.
Other conditions that mat result in spinal cord depression at any age are: abnormal alignment of the spine, injury to the spine, tumors of the spine, certain diseases, infectious diseases affecting the spine and rheumatoid arthritis ("Spinal Cord Compression | Johns Hopkins Medicine Health Library") .
(Spinal Cord Depression)
Other causes leading to spinal cord depression are ruptured disk, swelling of the spinal cord occurring as a result of injury, and bleeding disorders along with Chiropractic manipulations can lead to development of large blood clots which may cause cord compression ("Spinal Cord Compression").
The common cause of spinal cord compression among the patients of cancer is the metastasis of the tumor to the spine. Almost any type of cancer may metastasise to the spine including breast cancer, lung cancer, prostate cancer, lymphomas, kidney cancer and multiple myelomas.
Clinical Manifestations
The clinical manifestations may vary from person to person. The symptomatology largely depends on the region of the spinal cord affection and the nerves involved. The initial manifestation may be slight pain in the back which may further progress to increased pain sensation. In case of a tumor, the larger the tumor grows, more pressure is put on the spine by the growing tumor, leading to pain in the concerned region and symptoms of the area supplied by the affected nerve.
Commonest symptoms include pain in the neck or the back. The patient may feel as if his chest and the abdomen are being tied by a band. The pain may radiate further to the back, buttocks or into the legs or arms. The patient may experience an aggravation in the pain when he lies down. Other remarkable symptoms of spinal cord compression includes: numbness and tingling sensation in the arms or the legs, an unsteady gait or difficulty in walking, difficulty in passing urine with less or no urinary output, urinary or bowel incontinence, or constipation (“Spinal Cord Compression- Canadian Cancer Society”).
Many a times, the patient remains completely asymptomatic. In such cases, the patient should be monitored regularly to keep a check on the disease condition (Ullrich). Other important symptoms can be burning pain along the buttocks, arm or in the legs. The leg pain may resemble the pain of sciatica. Loss of sensation in the feet can be a major problem. There can be some difficulty in performing smaller tasks involving the fingers or in other words, there can be poor hand movement coordination.
One very important symptom of the disease condition is mental depression. It has been recorded that almost 30 percent of the patients of Spinal Cord Injury do suffer from depression and mental anxiety. The reason behind this however, has not been very clearly mentioned in the researches (Craig, Hancock and Dickson). The psychological effects leading to anxiety and depression are more evident in the acute phases of the condition (Kennedy and Rogers).
(Depression After Spinal Cord Injury (SCI))
Diagnostic Tests
Diagnosis may be done with the help of a number of tests including physical examination, radiological investigations and certain blood tests. Physical examination should be given utmost importance as it will help in early diagnosis of the condition and a good physical examination lays the foundation for a proper diagnosis. Radiological examinations and blood tests help in corroborating the physical findings with the most probable diagnosis. The physical examination of the patient should consist of a thorough examination of all the systems. However, the main emphasis should be laid on the nervous system. The physical examination should consist of all the important elements including inspection, palpation, and percussion, wherever needed.
The examination should be performed starting from the neck region, further rogressing downwards to the thoracoabdominal area, and finally ending with the lumbosacral region. It is important to perform examination of the hip joint and the sacroiliac joints. The physician should also consider examining the abdominal and cardiovascular system as any condition of these systems may also reflect symptoms corresponding to the nervous system and make the correct diagnosis more difficult (Tidy). Diagnostic tests involve X ray of the spine. The X ray may show bony growth known as spurs which push out the spinal nerves. The X ray film may also abnormal alignment of the spine. Other imaging tests of the spine may include a CT scan and MRI. These tests give more detailed look into the spinal cord and other structures surrounding the cord. Other studies may include a bone scan, a myelogram and electromyography or electrical test of muscle activity ("Spinal Cord Compression | Johns Hopkins Medicine Health Library").
Treatment of Spinal Cord Depression
The treatment of the disease condition depends largely on the cause of the disease. Most commonly, surgery is considered to be the most appropriate treatment option. In many cases, corticosteroids are given through intravenous injections. In case the symptoms have been evident due to a tumor, radiation therapy may be considered along with or without surgical intervention. In cases of abscesses or haematoma, draining is considered as the best option. If the functional loss is acute, then the compression should be released as soon as possible. If compressions are detected and treated at the earliest, before the nerve paths are completely destroyed, the treatment can prevent the permanent damage to the spinal cord and hence the normal functioning can be restored completely. Surgery is mostly needed to relieve the compression. It may also be required in order to insert steel rods, pins, or screws for stabilizing the spine. Other forms of treatment depend largely on the cause of the disease. For disorders like tumors or injuries to the spine high doses of corticosteroids are given intravenously. Corticosteroids can help in reducing the swelling around spinal cord. After corticosteroids are administered the tumors are usually removed surgically with or without the help of Radiation therapy. If the cause of the condition is a cancer, then the treatment indicates surgery (with or without radiation therapy). In case of an absence leading to spinal cord dysfunction, a neurosurgeon will proceed with removing the abscess at the earliest. Antibiotics are also given to control for the progression of the condition or to prevent the reappearance of abscess. If the spinal cord dysfunction symptoms have not developed by then, the physician still should consider draining out of the abscess first along with antibiotics. In case a haematoma is the cause of the disease, the accumulated blood needs to be surgically drained out. People with bleeding disorders who are on anticoagulant are administered injection of Vitamin K and plasma transfusion is done in order to eliminate or reduce the tendency for excessive bleeding ("Compression of the Spinal Cord").
Conclusion
In conclusion, it can be said that the disease condition may affect almost any age group irrespective of their gender. The commonest causes of the disease are injury to the spinal cord and osteoarthritis or progressive degeneration of the spine. The disease manifests itself with symptoms related to the nervous system of the body; tingling, numbness, weakness and depression are some of the presenting features. The diagnosis of the condition involves thorough physical examination and certain radiological examinations. Lastly, the treatment of the condition depends on the cause of the disease and usually consists of surgical interventions, radiotherapy and corticosteroid administration.
Works Cited
"Compression Of The Spinal Cord". MSD Manual Consumer Version. N.p., 2016. Web. 13 Mar. 2016.
"Spinal Cord Compression - Canadian Cancer Society". www.cancer.ca. N.p., 2016. Web. 13 Mar. 2016.
"Spinal Cord Compression | Johns Hopkins Medicine Health Library". Hopkinsmedicine.org. N.p., 2016. Web. 13 Mar. 2016.
"Spinal Cord Compression". Healthline. N.p., 2016. Web. 13 Mar. 2016.
Craig, A R, K M Hancock, and H G Dickson. "A Longitudinal Investigation Into Anxiety And Depression In The First 2 Years Following A Spinal Cord Injury". Paraplegia 32.10 (1994): 675-679. Web. 13 Mar. 2016.
Depression After Spinal Cord Injury (SCI). 2016. Web. 13 Mar. 2016.
Kennedy, Paul, and Ben A. Rogers. "Anxiety And Depression After Spinal Cord Injury: A Longitudinal Analysis". Archives of Physical Medicine and Rehabilitation 81.7 (2000): 932-937. Web. 13 Mar. 2016.
Spinal Cord Depression. 2016. Web. 13 Mar. 2016.
Tidy, Dr Colin. "Examination Of The Spine. Information About Spine Exams. Patient | Patient".Patient. N.p., 2016. Web. 13 Mar. 2016.
Ullrich, Peter F. "Spinal Cord Compression And Dysfunction From Cervical Stenosis". Spine- Health. N.p., 2016. Web. 13 Mar. 2016.
