Cervical spinal cord enlargement is an abnormal increase in the size of the spinal cord within the neck. The spinal cord, a delicate bundle of nerves, is housed within the confined space of the vertebral column. Any expansion can lead to pressure on these vital nerve pathways.
What is Cervical Spinal Cord Enlargement
The spinal cord transmits nerve signals between the brain and the body. It extends from the brainstem down to the lumbar region, encased within the vertebral column. The cervical portion runs through the neck, connecting the brain to the upper limbs and trunk.
The spinal cord naturally has two regions of increased diameter, called enlargements, which accommodate the greater number of nerves supplying the limbs. The cervical enlargement, located from the C3 to T2 spinal segments, houses neurons for motor and sensory functions of the shoulders, arms, and hands. Abnormal cervical spinal cord enlargement, beyond this normal variation, can compress the spinal cord, disrupting nerve signal transmission and leading to neurological impairment.
Common Causes of Enlargement
Cervical spinal cord enlargement can stem from various medical conditions, including inflammatory processes, abnormal growths, structural issues, and infections. Identifying the specific underlying cause is fundamental for effective intervention.
Inflammatory and Demyelinating Conditions
These conditions can lead to spinal cord swelling. Examples include Transverse Myelitis, Multiple Sclerosis, and Neuromyelitis Optica Spectrum Disorder (NMOSD), which involve inflammation or damage to the myelin sheath, the protective covering of nerve fibers. Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), a peripheral nerve disorder, can also cause spinal cord compression due to enlarged nerve roots.
Tumors
Tumors, or neoplasms, are a significant cause. Intramedullary tumors originate within the spinal cord tissue itself, such as ependymomas, astrocytomas, and hemangioblastomas. These abnormal growths can expand the spinal cord’s structure. Metastatic tumors, which spread from cancers elsewhere in the body, can also cause enlargement.
Vascular Malformations
Vascular malformations, characterized by abnormal blood vessels, can contribute to spinal cord enlargement. These include arteriovenous malformations (AVMs) and cavernous malformations. In AVMs, arteries connect directly to veins, bypassing capillaries, which can lead to increased pressure or bleeding within or around the spinal cord. Cavernous malformations are clusters of enlarged vessels that can leak blood, causing pressure on the spinal cord.
Infections
Infections within or around the spinal cord can lead to enlargement through inflammation and pus formation. Spinal abscesses, collections of infected material, can form directly in the spinal cord or surrounding epidural space. Bacterial infections, like Staphylococcus aureus, are common, but fungal or viral infections can also be responsible.
Congenital or Developmental Abnormalities
These can also result in cervical spinal cord enlargement. Syringomyelia is a neurological disorder characterized by the formation of a fluid-filled cyst (syrinx) within the spinal cord. This syrinx can expand over time, enlarging the spinal cord. Chiari malformation, where brain tissue extends into the spinal canal, can obstruct cerebrospinal fluid flow, leading to a syrinx and subsequent spinal cord enlargement.
Recognizing the Symptoms
Symptoms of cervical spinal cord enlargement arise from pressure on or damage to the spinal cord. These can vary based on the enlargement’s location and extent, with onset being gradual or sudden.
Individuals may experience motor weakness in their arms, hands, or legs, indicating impaired nerve signals to muscles. Sensory changes are common, including numbness, tingling, or altered sensation in the arms, hands, or shoulders. Pain in the neck, arms, or shoulders can also be a symptom.
Balance and coordination issues frequently occur, making walking difficult and increasing the risk of falls. Fine motor skills may also be affected, leading to clumsiness or difficulty with tasks requiring precision. In advanced cases, bladder or bowel dysfunction can develop, signifying broader neurological impairment. Muscle spasticity may also be present.
How Enlargement is Diagnosed
Diagnosing cervical spinal cord enlargement involves clinical assessment and specialized imaging. A neurological examination is typically the first step, where a medical professional assesses reflexes, muscle strength, and sensation to identify areas of neurological deficit.
Imaging studies are essential for visualizing the spinal cord and identifying enlargement. Magnetic Resonance Imaging (MRI) is the most effective diagnostic tool, providing detailed images of soft tissues. Computed Tomography (CT) scans may also be used when MRI is not feasible. In some cases, a lumbar puncture (spinal tap) might be performed to analyze cerebrospinal fluid for indicators of inflammation, infection, or tumor cells.
Treatment Approaches
Treatment for cervical spinal cord enlargement is individualized, depending on the underlying cause and symptom severity. The primary goal is to alleviate pressure on the spinal cord, manage symptoms, and prevent further neurological damage.
For stable or non-progressive cases, careful observation and monitoring may be the initial approach. Medical management often involves medications like corticosteroids to reduce inflammation, chemotherapy for tumors, or antibiotics for infections.
Surgical intervention is frequently considered, especially with significant spinal cord compression or progressive neurological deficits. Procedures might include tumor removal or decompression surgery to relieve pressure from cysts or vascular malformations. Radiation therapy may also be used for specific tumors, either as a primary treatment or with surgery. Following treatment, rehabilitation, including physical and occupational therapy, helps individuals regain function and manage persistent symptoms.