Spinal cord compression physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

The most significant physical examination findings in acute cases is point tenderness of back. Other physical examination findings include paralysis of limbs below the level of compression, decreased sensation below the level of compression, Lhermitte’s sign (intermittent shooting electrical sensation), hyperreflexia, Babinski sign positive.^[1]

Physical Examination

General Appearance

Patients may appear in acute distress due to back pain.

Vital signs

Hypotension in case of neurogenic shock
Hypothermia

Back

Point tenderness at the site of compression
Decreased range of motion

Neurologic

Paralysis of limbs below the level of compression
Hypoaesthesia below the level of compression
Lhermitte’s sign (intermittent shooting electrical sensation)
Hyperreflexia may be present.
Upward plantar reflex (Babinski sign)

ASIA Impairment Scale for Traumatic Spinal Cord Injury♠
Grade	Impairment
A	Complete: no sensory or motor function is preserved in segments S4–S5.
B	Sensory incomplete: sensory but not motor function is preserved below the neurologic level of injury and includes the S4–S5 segment No motor function is preserved more than three levels below the motor level on either side of the body.
C	Motor incomplete: motor function is preserved at the most caudal sacral segments for voluntary anal contraction, or sensory function is preserved at the most caudal sacral segments (S4–S5), with some sparing of motor function more than three levels below the motor level on either side of the body.
D	Motor incomplete: motor function is incomplete as defined above, with muscle power ≥3 for at least half the key muscle functions below the neurologic level of injury.†
E	Normal: sensory and motor function are normal.
♠ Data are adapted from the American Spinal Injury Association (ASIA). † Muscle power is graded on a scale from 0 (no muscle contraction) to 5 (normal power).

References

↑ Ropper, Alexander E.; Longo, Dan L.; Ropper, Allan H. (2017). “Acute Spinal Cord Compression”. New England Journal of Medicine. 376 (14): 1358–1369. doi:10.1056/NEJMra1516539. ISSN 0028-4793.

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[RopperLongo2017-1] Ropper, Alexander E.; Longo, Dan L.; Ropper, Allan H. (2017). “Acute Spinal Cord Compression”. New England Journal of Medicine. 376 (14): 1358–1369. doi:10.1056/NEJMra1516539. ISSN 0028-4793.

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