INVESTIGATIONS INVESTIGATIONS ANDAND

MANAGEMENTMANAGEMENT

INVESTIGATIONSINVESTIGATIONS

►BLOOD ROUTINE EXAMINATIONBLOOD ROUTINE EXAMINATION

Total count, Differential count, ESRTotal count, Differential count, ESR

ESR is elevated in inflammatory ESR is elevated in inflammatory conditionsconditions

Blood film may show megaloblastic Blood film may show megaloblastic anemia in sub a/c combined anemia in sub a/c combined degeneration of spinal corddegeneration of spinal cord

URINEURINE – Routine and culture and – Routine and culture and sensitivity test to be donesensitivity test to be done

►MANTOUX TESTMANTOUX TEST – positive in – positive in TuberculosisTuberculosis

►CHEST X-RAYCHEST X-RAY – To exclude TB, – To exclude TB, bronchogenic carcinoma or bronchogenic carcinoma or mediastinal widening (lymphoma)mediastinal widening (lymphoma)

X-RAY SPINEX-RAY SPINE ( (antero – posterior view and antero – posterior view and lateral view)lateral view)MAY SHOW-MAY SHOW-

o TB spineTB spineo collapse or erosion of vertebraecollapse or erosion of vertebraeo Herniated intervertebral discHerniated intervertebral disco Metastatic depositsMetastatic depositso Fracture or dislocation of vertebraFracture or dislocation of vertebra

CSF EXAMINATIONCSF EXAMINATION

• Features of Froin’s loculation Features of Froin’s loculation syndromesyndromeo low pressure

o xanthochromia

o clot formation in standing

o high protein content

o positive Queckenstedt’s test

Inflammatory lesions cells and proteins are Inflammatory lesions cells and proteins are increasedincreased

► In malignancy malignant cells may be In malignancy malignant cells may be presentpresent

MYELOGRAPHYMYELOGRAPHY

HELPS IN DETECTION OF LEVEL OF HELPS IN DETECTION OF LEVEL OF COMPRESSIONCOMPRESSION

NOW A DAYS COMBINED CT NOW A DAYS COMBINED CT MYELOGRAPHY IS DONEMYELOGRAPHY IS DONE

NERVE CONDUCTION STUDIESNERVE CONDUCTION STUDIES – to help in – to help in diagnosis of neuropathiesdiagnosis of neuropathies

► FUNDOSCOPYFUNDOSCOPY – for papilloedema due to – for papilloedema due to intracranial tumor of multiple sclerosisintracranial tumor of multiple sclerosis

► BONE SCANBONE SCAN – metastatic deposits and – metastatic deposits and inflammatory vertebral lesions are detectedinflammatory vertebral lesions are detected

►MISCELLANEOUSMISCELLANEOUS muscle biopsy, muscle enzymes, blood for muscle biopsy, muscle enzymes, blood for

VDRL and HIV tests (tests for non-VDRL and HIV tests (tests for non-compressive myelopathy)compressive myelopathy)

MANAGEMENTMANAGEMENT

► NUTRITIOUS DIETNUTRITIOUS DIET – – In an adult In an adult 3500 cal/day should be given3500 cal/day should be given

No necessity to put the No necessity to put the patient on Ryle’s tubepatient on Ryle’s tube

CARE FOR BLADDER, BOWEL AND CARE FOR BLADDER, BOWEL AND TROPHIC ULCERSTROPHIC ULCERS

BLADDERBLADDER : : put self retaining catheter put self retaining catheter under aseptic conditionsunder aseptic conditions

a)a)change catheter at regular intervals(2-change catheter at regular intervals(2-3 weeks)3 weeks)

b)b)bladder washbladder washc)c)help in bladder control by application help in bladder control by application

of clip to drainage tubeof clip to drainage tubed)d)routine urine examination and culture routine urine examination and culture

and sensitivity, antibiotics inand sensitivity, antibiotics in UTIUTI

BOWELBOWEL1.1. Treatment of constipation is done by Treatment of constipation is done by

laxativeslaxatives2.2. Renal incontinence is difficult to treatRenal incontinence is difficult to treat TROPHIC ULCERSTROPHIC ULCERS 1.1. Cleaned by hydrogen peroxideCleaned by hydrogen peroxide2.2. Protect other pressure points by adhesive Protect other pressure points by adhesive

plasters, plastic surgery if necessaryplasters, plastic surgery if necessary

MUSCLE SPASMS MUSCLE SPASMS are treated by are treated by diazepam, baclofen (5mg,TDS,orally)diazepam, baclofen (5mg,TDS,orally)

THE UNDERLYING CAUSE SHOULD BE THE UNDERLYING CAUSE SHOULD BE TREATEDTREATED

In TB spineIn TB spine : application of traction in : application of traction in early stageearly stage

later on plastic jacket applied for later on plastic jacket applied for immobilizationimmobilization

Ant tuberculosis chemotherapy for 1 yrAnt tuberculosis chemotherapy for 1 yr TREATMENT OF CARCINOMA ORTREATMENT OF CARCINOMA OR LYMPHOMALYMPHOMA

by radiotherapy or chemotherapyby radiotherapy or chemotherapy A/C TRANSVERSE MYELITIS A/C TRANSVERSE MYELITIS : ACTH or : ACTH or

corticosteroidscorticosteroids

PHYSIOTHERAPYPHYSIOTHERAPY

• To obtain max. development of all those To obtain max. development of all those muscles in which voluntary power remainsmuscles in which voluntary power remains

• Prevention of flexor contractures in lower Prevention of flexor contractures in lower limbslimbs

• Passive movements are carried out in LL Passive movements are carried out in LL once or twice dailyonce or twice daily

• Later on arrangement of wheel chair, Later on arrangement of wheel chair, walking calipers done according to walking calipers done according to necessitynecessity

SURGERYSURGERY

• Drainage of cold abscess, fusion of Drainage of cold abscess, fusion of vertebra, laminectomy for TB spine, vertebra, laminectomy for TB spine, skin grafting for bed soreskin grafting for bed sore