Spinal chord compression

Question 1

Definition

Answer 1

Spinal cord compression (SCC) results from processes that compress or displace arterial, venous, and cerebrospinal fluid spaces, as well as the cord itself.

Question 2

Clinical features

Answer 2

Cord compression typically presents with acute (or less commonly subacute) upper motor neuron signs and sensory disturbance below the level of the lesion.

Deep and localised back pain is often also present, along with a stabbing radicular sensory disturbance at the level of the lesion. Bladder and bowel involvement is also commonly seen.

Question 3

Causes

Answer 3

Trauma

Neoplasia (seen in 5-10% of cancer patients, presenting complaint in 20% of these)

Infection (especially TB in at-risk patients)

Disc prolapse

Epidural haematoma

Question 4

Management

Answer 4

Patient with clinical features suggestive of spinal cord compression or cauda equina syndrome should have an urgent WHOLE spine MRI, with an aim (in appropriate cases) to surgically decompress within 48 hours.

In patients where malignancy is demonstrated on MRI, or in patients where clinical suspicion is high, administration of dexamethasone 16 mg daily in divided doses (with PPI cover) is indicated.