Spinal Cord Compression

How spinal cord compression affects the body

The spinal cord runs from the brain down the spinal canal to about the level of the first or second lumbar vertebra. Below that, nerve roots called the cauda equina continue downward. Pressure on the cord reduces blood flow and directly injures nerve fibers, interrupting signals for movement, sensation and bladder and bowel control below the level of compression. Compression below the end of the cord affects the cauda equina instead (cauda equina syndrome), with similar urgency.

Causes

Sudden (acute) causes

• Metastatic cancer: cancers of the breast, lung, prostate and kidney, multiple myeloma and lymphoma can spread to the spine and press on the cord. Metastatic spinal cord compression affects a significant minority of people with advanced cancer and is sometimes the first sign of cancer. See metastatic cancer.
• Epidural abscess: an infection in the spinal canal, causing back pain, fever and rapidly progressive weakness.
• Trauma: fractures and dislocations. See spinal cord injury.
• Large disc herniation
• Bleeding into the spinal canal, particularly in people on blood thinners

Gradual (chronic) causes

• Cervical spondylotic myelopathy: age-related arthritis and disc degeneration narrow the canal in the neck. It is the most common cause of spinal cord dysfunction in older adults. See cervical spondylosis.
• Spinal stenosis in the neck or upper back
• Benign tumors such as meningiomas and nerve sheath tumors
• Rheumatoid arthritis affecting the upper neck
• Paget's disease and other bone diseases

Symptoms

• Back or neck pain: often the first symptom, especially with cancer. It may be worse when lying down, at night, or with coughing, sneezing or straining
• Band-like pain around the chest or abdomen
• Weakness, stiffness or heaviness of the legs (or arms with neck compression)
• Numbness, tingling or reduced sensation below a certain level
• Difficulty walking, unsteadiness and falls
• Clumsy hands and difficulty with fine tasks (neck compression)
• Bladder problems: difficulty starting urination, retention or incontinence
• Bowel problems: constipation or incontinence
• Sexual dysfunction

Bladder and bowel symptoms and inability to walk are late signs. The goal is to diagnose compression before these develop.

Diagnosis

• Neurological examination: strength, sensation, reflexes, walking and anal tone.
• MRI of the whole spine: the key test, ideally within hours for suspected acute compression. The whole spine is imaged because cancer can affect several levels.
• CT if MRI is not possible, and for fractures.
• Blood tests: infection markers and blood cultures for suspected abscess, and tests for cancer or myeloma.
• Biopsy if a tumor is found without a known cancer.

Treatment

Emergency treatment

• Corticosteroids (dexamethasone) to reduce swelling around the cord in cancer-related compression
• Pain control
• Spine stabilization and careful handling after trauma, or when the spine may be unstable

Definitive treatment

• Surgical decompression: removing the material pressing on the cord, often with stabilization using rods and screws. Surgery followed by radiation gives better results than radiation alone for selected people with metastatic compression.
• Radiation therapy: for cancer-related compression, especially when surgery is not suitable.
• Antibiotics and drainage for epidural abscess.
• Planned surgery for progressive cervical myelopathy, to halt deterioration.
• Rehabilitation: physical and occupational therapy, bladder and bowel management.

Outlook

The most important factor is the ability to walk at the time of treatment. People who can still walk when treated usually keep that ability, while those who have already lost it are less likely to recover. This is why rapid recognition and treatment matter. Chronic compression often stabilizes after surgery, with some improvement.

Frequently asked questions

What are the first signs of spinal cord compression?

Often the first sign is new or worsening back or neck pain, which may be worse at night, lying down, or with coughing. This can be followed by limb weakness or heaviness, numbness, tingling, unsteady walking, and later bladder or bowel problems. Neurological symptoms need emergency care.

What causes spinal cord compression?

Causes include cancer spreading to the spine, infection (epidural abscess), fractures, large disc herniations, bleeding, and gradual narrowing from arthritis and disc degeneration in the neck (cervical myelopathy). Benign tumors and rheumatoid arthritis are less common causes.

Is spinal cord compression an emergency?

Sudden spinal cord compression is a medical emergency. Delays can lead to permanent paralysis and loss of bladder and bowel control. Anyone with new weakness, numbness, difficulty walking or bladder or bowel problems with back pain should call 911 or go to the ER.

Can spinal cord compression be reversed?

Often partly, if treated quickly. People who can still walk at the time of treatment usually keep walking. Function lost for a longer time is less likely to return. Surgery, radiation, steroids or antibiotics, depending on the cause, give the best results when started early.