Non-traumatic spinal cord compression and its interference with driving
Also, due to chronic compressive myelopathies secondary to a combination of disk compression, formation of osteophytes and stenosis of the marrow canal.
In addition to, due to epidural bleeding, epidural abscess or acute discal hernia.
The symptoms are characterized by lesional, sublesional and sometimes spinal syndrome.
Lesional syndrome
It is evidenced by the affectation of one or more roots at the site of compression, with radicular pain usually live, fixed, resistant to treatment and worsened by Valsalva maneuvers.
It can be associated with hypoesthesia in band, or amyotrophic paralysis.
Sublesional syndrome
It indicates the functional interruption of ascending or descending medullary fascicles.
- Motor disorders: In the beginning gait can be intermittently affected, with hesitation in one extremity and fatigue of the leg after the movement.
- It is first unilateral and then bilateral. Later, the disorders become permanent and gait is rigid, spastic, and finally impossible.
- Sensory signs: They follow the motor signs. Distal in the injury, pain on pressure and multiple paresthesia, with more involvement of thermal an painful sensitivtiy than positional sensitivity.
- Sensory symptoms worsen slowly until they eventually become a complete anesthesia of the sublesional area.
- Sphincter disorders: They are relatively late and lead to an urgent, frequent urination that will limit driving.
Spinal syndrome
It is characterized by segmental stiffness mainly of the cervical and lumbar rachis, with painful deformation and pain on pressure of the spinal apophysis.
Semiologic variants of marrow compression
- High cervical:It causes spastic tetraplegia. Sometimes, it affects the phrenic nerve, with hemidiaphragmatic paralysis and the spinal marrow with paralyses of the trapezium and the sternocleidomastoid.
- Low cervical: It occurs as paraplegia and radicular syndrome of the arms.
- Dorsal: These are the most common and cause thoracoabdominal pain in the waist and paraplegia.
- Lumbosacral: Due to the anatomical characteristics of the area, the injuries, though small, affect several medullary segments and roots. Sphincter disorders are constant and early. Flaccid paralysis of the quadriceps occurs frequently, that will hinder the use of the driving pedals.
- Cauda equina: It consists of a flaccid paralysis with amyotrophy of the lower extremities, and pain irradiating to the low back area to the buttocks and lower extremities by the posterior side of the thighs and legs. Urinary disorders are constant. They can be unilateral, but immediately they occur bilaterally.
Treatment of non-traumatic marrow compression
High-dose glucocorticoids are prescribed to reduce the edema by metastatic tumor compression. Radiation therapy and chemotherapy will be indicated in the selected cases.
Decompression surgery will be required in the removal of neurofibromas, meningiomas, other extramedullary tumors, discal hernia and for drainage of purulent or blood collections.
Advice on non-traumatic spinal cord compression
- While the patient has symptoms, such as pain, loss of strength and sensory disorders, he must not drive.
- After surgery, the convalescence period remains to medical criterion to be able to drive without limitations.
- The sequels should be evaluated and noted in a report, with the evolution of the patient and the indication in every review with regard to driving.
- The permanent disabilities can be evaluated with the report of the specialized physician, in order to attempt to adapt the vehicle to the driver and permit driving with the restrictions set out by the law for each case.