Spinal Cord Compression

Definition

Spinal cord compression refers to any condition that puts pressure on the spinal cord, resulting in neurological impairment. It can occur anywhere along the spine and may cause symptoms such as pain, numbness, and weakness. Prompt diagnosis and treatment are critical to prevent permanent damage.

Aetiology

Spinal cord compression can result from various causes, including:

Trauma: Vertebral fractures or dislocations.
Tumours: Primary spinal tumours or metastases from other cancers.
Degenerative diseases: Spinal stenosis, herniated discs, and osteoarthritis.
Infections: Abscesses, osteomyelitis, and discitis.
Inflammatory conditions: Rheumatoid arthritis, ankylosing spondylitis.

Pathophysiology

Spinal cord compression occurs when an external force applies pressure to the spinal cord, disrupting the normal function of the neural pathways. This can lead to a reduction in blood supply, inflammation, and direct injury to the spinal cord tissue, resulting in neurological deficits.

Risk Factors

Age: Increased risk with advancing age.
History of cancer: Particularly cancers that metastasise to the spine.
Pre-existing spinal conditions: Such as spinal stenosis or previous spinal injury.
Infection risk factors: Immunosuppression or intravenous drug use.

Signs and Symptoms

Back pain: Often severe and progressive.
Neurological deficits: Weakness, numbness, or tingling in the limbs.
Loss of bladder or bowel control.
Gait disturbance and difficulty walking.
Hyperreflexia or hyporeflexia.

Investigations

Clinical history and physical examination, including a thorough neurological assessment.
Magnetic Resonance Imaging (MRI) of the spine: The gold standard for diagnosing spinal cord compression.
Computed Tomography (CT) scan if MRI is contraindicated or unavailable.
Blood tests: To identify infection or underlying malignancy.
Biopsy: If a tumour is suspected, to determine the type of tumour.

Management

Primary Care Management

Initial assessment and stabilisation of the patient.
Immediate referral to a specialist (neurologist or neurosurgeon) if spinal cord compression is suspected.
Pain management and supportive care while awaiting specialist assessment.

Specialist Management

Surgical intervention: Decompression surgery to relieve pressure on the spinal cord.
Radiotherapy: Often used for spinal tumours or metastases.
Medications: Corticosteroids to reduce inflammation and swelling.
Antibiotics: If infection is the underlying cause.
Rehabilitation: Physiotherapy and occupational therapy to aid recovery and improve function.
Long-term follow-up: Regular monitoring and management of any complications or recurrence.

Example Management for Spinal Cord Compression

A patient presenting with symptoms of spinal cord compression, such as severe back pain and limb weakness, should be urgently referred to a specialist. An MRI should be performed to confirm the diagnosis and identify the cause. If a tumour is causing the compression, surgical decompression may be necessary, followed by radiotherapy. Corticosteroids may be administered to reduce inflammation. The patient should receive multidisciplinary care, including physiotherapy to aid recovery and regular follow-up to monitor for any recurrence or complications.

References

NICE. (2024). Metastatic Spinal Cord Compression in Adults: Risk Assessment, Diagnosis, and Management. Retrieved from NICE
NHS. (2023). Spinal Cord Compression. Retrieved from NHS
American Association of Neurological Surgeons. (2016). Spinal Cord Tumors. Retrieved from AANS
Bach, F., et al. (1990). Metastatic Spinal Cord Compression. Journal of Clinical Oncology.
Smith, J. S., et al. (2015). Spinal Decompression Surgery. Spine.