Spinal cord compression (summary)

Jason Chan and Dr Derek Smith et al.

 

Spinal cord compression is a surgical emergency and if unrecognised or untreated, can result in irreversible neurological damage and disability. If the spinal roots below the conus medullaris are involved, it is termed cauda equina syndrome.

Reference article

This is a summary article; read more in our article on spinal cord compression.

  • anatomy
  • epidemiology
    • number of different causes
    • different patient groups for each pathology
    • may affect all age groups
  • presentation
    • may be a mixed clinical picture
    • back pain - red flags
      • history of malignancy
      • violent trauma: e.g. fall from a height, road traffic accident (case 1)
      • thoracic or radicular pain
      • constant, progressive, non-mechanical pain
      • systemically unwell
      • widespread neurological signs and symptoms
    • power reduction: 80% of patients need help to mobilise
    • loss of sensation: saddle anaesthesia
    • urinary retention
  • pathophysiology
    • cord compression from canal invasion
      • mechanical
        • disc herniation
        • fractures (traumatic/osteoporotic)
      • malignancy (2.5% of cancer cases 1)
        • vertebral metastasis: lung, prostate, breast, myeloma 1
        • primary CNS tumours
        • other metastases
      • infective sources
        • discitis
        • epidural abscesses
  • investigation
    • MRI spine should be performed urgently
      • it is the only imaging option - CT will not suffice
  • treatment
    • high dose IV steroids reduces oedema
    • surgical decompression may be an option
    • radiotherapy is used in cases caused by malignancy
  • confirmation of spinal cord compression
  • assessment of the likely cause of compression

This is a largely non-specific investigation which may show metastatic deposits or vertebral compression but cannot be used to assess the spinal cord or identify a cause. These are sometimes used in pre-operative planning.

CT can be used to allow detailed assessment of bony injury or disruption (case 1), but cannot be used to assess the cord. It can also be used to identify other bone tumours elsewhere (although this is often incidental).

This is the gold-standard in imaging for suspected spinal cord compression or cauda equina syndrome 2. It should be performed urgently in those with neurological signs and immediately in those with suspected malignancy or infection.

MRI allows best imaging of the spinal canal and its contents. Different sequences can discriminate changes in bone (case 2), while T2 images can highlight the CSF spaces which can be diminished in canal compression (case 1) or compromise to the cord itself.

Further investigations can include PET or bone scans to investigate other metastatic or destructive processes. However, these would be performed following emergency treatment of any cord compression.

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rID: 34296
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Cases and figures

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    Case 1: CT in spinal fracture - sagittal bone window
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    Case 2: T11 and L3 vertebral metastases from renal cell carcinoma (sagittal T1 C+ fat sat))
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    Case 3: multiple bony and soft tissue metastatic deposits throughout cervical, thoracic and lumbar spine (MRI sagittal T2)
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