Spinal Cord Compression

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management

Definition

Spinal cord compression is a condition where pressure on the spinal cord results in neurological deficits, including motor, sensory, and autonomic dysfunction. It is a medical emergency if acute.

Aetiology

1. Traumatic Causes:

  • Fractures or dislocations of the vertebrae (e.g., following road traffic accidents, falls).
  • Spinal haematomas.

2. Malignant Causes (Metastatic Spinal Cord Compression - MSCC):

  • Metastases from lung, breast, prostate, or haematological malignancies.
  • Primary spinal tumours (e.g., meningiomas, gliomas).

3. Degenerative Causes:

  • Cervical spondylotic myelopathy.
  • Osteophytes causing spinal stenosis.

4. Infective Causes:

  • Spinal epidural abscess (e.g., due to staph. aureus).
  • Pott’s disease (tuberculous spondylitis).

Pathophysiology

  • Compression of the spinal cord impairs blood supply, leading to ischaemia.
  • Neuronal damage occurs due to mechanical pressure and inflammation.
  • Chronic compression results in progressive demyelination and axonal loss.

Risk factors

  • History of malignancy (especially lung, breast, prostate cancer).
  • Osteoporosis (risk of vertebral fractures).
  • Chronic spinal degenerative disease.
  • Immunosuppression (risk of spinal infections).
  • Previous spinal surgery.

Signs and symptoms

Red Flag Symptoms (Suggesting Acute Compression):

  • Severe back pain, worse at night or lying flat.
  • Weakness below the level of compression.
  • Sensory loss or paraesthesia.
  • Loss of bladder or bowel control (suggestive of cauda equina syndrome).
  • Hyperreflexia and spasticity (upper motor neuron signs).

Investigations

  • Emergency MRI Spine: first-line imaging to confirm compression.
  • X-ray spine: may show vertebral fractures, lytic lesions.
  • CT spine: used if MRI is contraindicated.
  • Blood tests:
    • FBC (infection or malignancy).
    • Inflammatory markers (CRP, ESR – raised in infection or malignancy).
    • Calcium levels (hypercalcaemia in metastatic disease).

Management

1. Emergency Management (if Acute Spinal Cord Compression Suspected or cauda eq):

  • Urgent neurosurgical referral.
  • Dexamethasone 16 mg STAT (reduces oedema and inflammation).
  • Strict spinal immobilisation if traumatic cause suspected.

2. Definitive Management:

For Malignant Causes (MSCC) urgent oncology or 2ww referral:
  • Radiotherapy for metastatic disease.
  • Surgical decompression if radioresistant tumour or unstable spine.
For Traumatic Causes:
  • Spinal stabilisation surgery (laminectomy, spinal fusion).
For Infectious Causes:
  • IV antibiotics if spinal epidural abscess.
  • Surgical drainage if abscess is large or causing significant compression.

3. Rehabilitation and Supportive Care:

  • Physiotherapy to improve mobility and prevent contractures.
  • Pain management with analgesics, neuropathic pain agents.
  • Bladder and bowel management (catheterisation if retention present).
NeurologymypanotesSpinal Cord Compression