Spinal cord compression

Spinal cord compression (SCC) is a surgical emergency, usually requiring prompt surgical decompression to prevent permanent neurological impairment. If the spinal roots below the conus medullaris are involved, and there are characteristic symptoms and signs, it is termed cauda equina syndrome.

Pathology

Etiology

There are numerous causes of cord compression. These can be divided according to the location of the compressing mass:

• intervertebral disc

  • disc protrusion/disc extrusion

  • discitis osteomyelitis (usually associated with an epidural abscess)

  • degenerative anterolisthesis/spondylosis

• vertebral

  • trauma

    • vertebral fracture (e.g. burst fracture)

    • fracture-dislocation

  • tumor

    • vertebral metastasis

    • primary vertebral tumor (e.g. aggressive vertebral hemangioma)

• epidural space

  • epidural abscess or phlegmon

  • epidural hematoma

  • epidural metastasis 

• dura

  • spinal meningioma

  • spinal arachnoid cyst

  • ventral herniation of the cord

• intradural space

  • nerve sheath tumor (spinal schwannoma or neurofibroma)

Lesions of the cord itself can present in a similar manner to extrinsic cord compression but are usually considered separately (e.g. spinal cord tumors, spinal cord abscess).