Spinal cord compression (summary)

Dr Craig Hacking and Dr Derek Smith et al.
This is a basic article for medical students and other non-radiologists

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 spinal 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
  • role of imaging
    • confirm spinal cord compression
    • assessment of the likely cause of compression
  • radiographic features
    • plain film
      • has no place in the assessment of cord compression
      • may show a lucent bone lesion in metastasis as the cause
    • CT
      • similar to plain film, may help to determine a cause but cannot be used to accurately assess the cord
    • MRI
      • the investigation of choice in suspected cord compression 2
      • should be performed
        • urgently in those with neurological signs
        • immediately in those with suspected malignancy or infection
      • allows assessment of the canal and contents
      • signal change in the cord can help to determine the severity
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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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