Acute and subacute spinal cord disorders are an important area of hospital medicine given the high risk of devastating neurological complications. This chapter presents the clinical characteristics, diagnosis, differential diagnosis, treatment and prognosis of the following spinal disorders: spinal epidural abscess, transverse myelitis, cauda equina syndrome, spinal cord injury, vascular myelopathies, and neoplastic disorders. Spinal cord trauma can be acutely life-threatening or result in severe chronic disability. Appropriate initial management is crucial to maximizing eventual neurological function. Like cerebral stroke, vascular myelopathy is considered when myelopathic deficits develop abruptly. Spinal epidural abscess results from hematogenous seeding of infection either directly into the epidural space, or to the vertebral body or intervertebral disk with subsequent spread into the epidural space. Cauda equina syndrome (CES) is most commonly due to anatomical compression from a large central disc. Metastases are the most common type of tumor affecting the spine.

This chapter considers selected aspects of surgical technique, complications, and the management of some surgical problems that develop in association with pregnancy. The signs and symptoms of various surgical conditions are modified by the anatomic and physiologic changes that accompany pregnancy, paradoxically often resulting in their exacerbation, an apparent reduction in intensity, or a change in the location of the expected physical signs. Impaired healing and wound infections are among the most common complications of surgery, in pregnant as in nonpregnant patients. During abdominal surgery, iatrogenic injuries commonly involve the gastrointestinal and urinary tracts. Surgical complications involve gallbladder disease and appendicitis. The chapter discusses a series of neoplastic disorders encountered at varying degrees of frequency during pregnancy, and outlines their clinical management. In areas of developing surgical techniques, the most significant area of legal exposure falls in the lag between actual practice and the establishment of accepted safeguards.