Spinal Cord Compression

Spinal cord compression is characterised by a combination of a progressive history of neurological deficit and a sensory level on examination.

This is a lesion that causes lower motor neurone signs at the level of the lesion and upper motor neurone lesions below that level.

It is a neurological emergency because:

  • the final events are ischaemic, so they are fast and irreversible
  • the patient may be left in a wheelchair, incontinent of urine

Pain characteristics suggesting spinal metastases:

  • severe unremitting back pain
  • progressive back pain
  • mechanical pain (aggravated by standing, sitting or moving)
  • back pain aggravated by straining (for example, coughing, sneezing or bowel movements)
  • night-time back pain disturbing sleep
  • localised tenderness
  • claudication (muscle pain or cramping in the legs when walking or exercising)

Symptoms and signs suggesting cord compression:

  • bladder or bowel dysfunction
  • gait disturbance or difficulty walking
  • limb weakness
  • neurological signs of spinal cord or cauda equina compression
  • numbness, paraesthesia or sensory loss
  • radicular pain

Note that the commonest cause of acute cord compression is metastatic disease.

  • metastases to the spinal column are diagnosed in around 16% of all people with cancer and may cause pain, vertebral collapse and spinal cord or root compression
  • metastatic spinal cord compression (MSCC) develops in 40% of patients with pre-existing non-spinal bone metastasis
  • treatments for patients with MSCC differ based on their life expectancies
    • Decompressive surgery is considered to be the “gold standard” in tumours that are not specifically radiosensitive
      • To improve the quality of life, patients with a life expectancy of more than 3–6 months may undergo surgery
    • Evidence shows that survival of MSCC patients can be improved with palliative decompression before motor deficits occur.
    • After motor deficit onset, survival can still be improved with surgery within 7 days.
    • Overall survival is better in patients aged <=55 years