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Disorders affecting the spinal cord

Andrew Eisen, MD, FRCPC
Section Editor
Michael J Aminoff, MD, DSc
Deputy Editor
Janet L Wilterdink, MD


Pathologies that affect the spinal cord are diverse. In addition to trauma, common etiologies of myelopathy include autoimmune, infectious, neoplastic, vascular, and hereditary-degenerative diseases. The relative incidence of each of these entities depends in large part upon the clinical setting. In a regional neuroscience center in the United Kingdom, the most common cause of spastic paraparesis or quadriparesis among 585 patients was cervical spondylotic myelopathy (24 percent), followed by tumor (16 percent), multiple sclerosis (18 percent), and motor neuron disease (4 percent) [1].

This topic will review some of the more common and important causes of nontraumatic spinal cord dysfunction. Clinical features of the more common of these disorders are summarized in the table (table 1). Traumatic spinal cord injury and the anatomy and clinical localization of spinal cord disease are discussed separately. (See "Acute traumatic spinal cord injury" and "Anatomy and localization of spinal cord disorders".)


Transverse myelitis — Transverse myelitis (TM) is a segmental spinal cord injury caused by acute inflammation [2-4]. TM is uncommon, with an approximate incidence of between one to five cases per million population annually [5].

Most cases of TM are idiopathic and presumably result from an autoimmune process; up to half of these patients have a preceding infection [6-8]. TM can also occur in multiple sclerosis (MS) and can be the presenting demyelinating event [9]. Neuromyelitis optica or Devic's disease is a disorder related to MS, in which demyelinating events are limited to the optic nerve and spinal cord. (See "Neuromyelitis optica spectrum disorders".)

TM is also associated with connective tissue diseases, including:


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