Show Summary Details
Page of

Diseases of the spinal cord 

Diseases of the spinal cord

Diseases of the spinal cord

A.J. Larner


February 27, 2014: This chapter has been re-evaluated and remains up-to-date. No changes have been necessary.


Chapter re-evaluated and minor changes made.

A relevant case history from Neurological Case Histories: Case Histories in Acute Neurology and the Neurology of General Medicine has been added to this chapter.

Updated on 28 Nov 2012. The previous version of this content can be found here.
Page of

PRINTED FROM OXFORD MEDICINE ONLINE ( © Oxford University Press, 2015. All Rights Reserved. Under the terms of the licence agreement, an individual user may print out a PDF of a single chapter of a title in Oxford Medicine Online for personal use (for details see Privacy Policy).

date: 30 March 2017

The spinal cord is subject to numerous pathological processes that can arise within (intramedullary) and/or extrinsic to the cord (extramedullary lesions).

Clinical features

Symptoms and signs suggestive of spinal cord disease include (1) motor—weakness and alteration in tone; acute cord lesions produce flaccidity (‘spinal shock’) and chronic processes spasticity, with hyper-reflexia, clonus, and upgoing plantar responses; pathological processes targeting lower motor neurons in the anterior horns typically produce early muscle wasting and fasciculation; (2) sensory—including numbness, loss of sensation, tingling, sensory ataxia; the demonstration of a sensory level and analysis of specific sensory deficit patterns are of particular importance in localizing the site, and therefore the likely cause, of any lesion; and (3) autonomic—sphincter dysfunction, most commonly affecting bladder function.

Other clinical features may give clues to the cause of spinal cord disease, e.g. multiple sclerosis, systemic lupus erythematosus (SLE), neurofibromatosis.


Intramedullary and extramedullary pathologies may produce distinguishable symptom profiles, but the clinical distinction can only ever be probabilistic. If there is acute onset of myelopathy, and/or structural disease is suspected, imaging of the cord is mandatory, with MRI the investigation of choice. Once structural lesions are excluded, further investigation depends on suspected cause (e.g. neurogenetic testing for some hereditary spastic paraplegias and spinocerebellar ataxias), and on geographical location or travel history (e.g. schistosome ova in faeces). Examination of the cerebrospinal fluid may be required.

Particular conditions affecting the spinal cord

Many diseases can affect the spinal cord. Those of particular note include (1) spondylotic myelopathy—the most common cause of progressive myelopathy due to cord compression; (2) multiple sclerosis—may present as an isolated cord syndrome, usually partial rather than complete; (3) transverse myelitis—most commonly affects the thoracic cord; there may be a preceding history of infection, and cerebrospinal fluid analysis may disclose an infective agent; (4) subacute combined degeneration of the cord—demyelination of the posterior and lateral columns due to vitamin B12 deficiency; may occur in the absence of haematological abnormality; (5) genetic disorders—hereditary spastic paraplegia is usually an autosomal dominant disorder; causative mutations have been described in several genes; (6) vascular disorders—anterior spinal artery occlusion can infarct whole or part of the anterior two-thirds of the cord; (7) syringomyelia; (8) injury/trauma—see Chapter 24.13.1; (9) motor neuron disease—see Chapter 24.15.

Treatment and prognosis

Specific medical and surgical treatments are determined by the particular cause of myelopathy. These may arrest progression, but function that has been lost does not usually recover. Prognosis of acute cord compression is directly related to the time delay between symptom onset and relief of compression. Chronic disability as a consequence of spinal cord disease requires intensive neurorehabilitation.

Access to the complete content on Oxford Medicine Online requires a subscription or purchase. Public users are able to search the site and view the abstracts for each book and chapter without a subscription.

Please subscribe or login to access full text content.

If you have purchased a print title that contains an access token, please see the token for information about how to register your code.

For questions on access or troubleshooting, please check our FAQs, and if you can''t find the answer there, please contact us.