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Spinal Cord Compression


Michael Rubin

, MDCM, New York Presbyterian Hospital-Cornell Medical Center

Reviewed/Revised Feb 2023
Topic Resources

Various lesions can compress the spinal cord, causing segmental sensory, motor, reflex, and sphincter deficits. Diagnosis is by MRI. Treatment is directed at relieving compression.

Compression is caused far more commonly by lesions outside the spinal cord (extramedullary) than by lesions within it (intramedullary).

Compression may be

  • Acute

  • Subacute

  • Chronic

Acute compression develops within minutes to hours. It is often due to

It is occasionally due to abscess and rarely due to spontaneous epidural hematoma. Acute compression may follow subacute and chronic compression, especially if the cause is abscess or tumor.

Subacute compression develops over days to weeks. It is usually caused by

  • A metastatic extramedullary tumor

  • A subdural or an epidural abscess or hematoma

  • A cervical or, rarely, thoracic herniated disk

Chronic compression develops over months to years. It is commonly caused by

Symptoms and Signs of Spinal Cord Compression

Acute or advanced spinal cord compression causes segmental deficits, paraparesis or quadriparesis, hyporeflexia (when acute) followed by hyperreflexia, extensor plantar responses, loss of sphincter tone (with bowel and bladder dysfunction), and sensory deficits. Subacute or chronic compression may begin with local back pain, often radiating down the distribution of a nerve root (radicular pain), and sometimes hyperreflexia and loss of sensation. Sensory loss may begin in the sacral segments. Complete loss of function may follow suddenly and unpredictably, possibly resulting from secondary spinal cord infarction.

Spinal percussion tenderness is prominent if the cause is metastatic carcinoma, abscess, or hematoma.

Intramedullary lesions tend to cause poorly localized burning pain rather than radicular pain and to spare sensation in sacral dermatomes. These lesions usually result in spastic paresis.

Diagnosis of Spinal Cord Compression

  • MRI or CT myelography

Spinal cord compression is suggested by spinal or radicular pain with reflex, motor, or sensory deficits, particularly at a segmental level.

Pearls & Pitfalls

  • If patients have sudden spinal or radicular pain with reflex, motor, or sensory deficits, particularly at a segmental level, image the spinal cord and treat the cause immediately.

MRI is done immediately if available. If MRI is unavailable, CT myelography is done; a small amount of iohexol (a nonionic, low osmolar radiopaque agent) is introduced via a lumbar puncture and allowed to run cranially to check for complete block of the cerebrospinal fluid (CSF). If a block is detected, a radiopaque agent is introduced via a cervical puncture to determine the rostral extension of the block. If traumatic bone abnormalities (eg, fracture, dislocation, subluxation) that require immediate spinal immobilization are suspected, plain spinal x-rays can be done. However, CT detects bone abnormalities better.

Treatment of Spinal Cord Compression

  • Relief of compression

Treatment of spinal cord compression is directed at relieving pressure on the cord. Incomplete or very recent complete loss of function may be reversible, but complete loss of function rarely is; thus, for acute compression, diagnosis and treatment must occur immediately.

If compression causes neurologic deficits or pain, IV dexamethasone, typically 10 mg, is given immediately, followed by 16 mg orally per day in divided doses. Surgery or radiation therapy. is done immediately.

Surgery is indicated in the following cases:

  • Neurologic deficits worsen despite nonsurgical treatment.

  • A biopsy is needed.

  • The spine is unstable.

  • Tumors recur after radiation therapy.

  • An abscess or a subdural or epidural hematoma is compressing the spinal cord.

Key Points

  • Spinal cord compression is usually secondary to an extrinsic mass.

  • Manifestations may include back and radicular pain (early) and segmental sensory and/or motor deficits, altered reflexes, extensor plantar responses, and loss of sphincter tone (with bowel and bladder dysfunction).

  • Do MRI or CT myelography immediately.

  • To relieve pressure on the cord, do surgery or give corticosteroids as soon as possible.

Drugs Mentioned In This Article

Drug Name Select Trade
AK-Dex, Baycadron, Dalalone, Dalalone D.P, Dalalone L.A, Decadron, Decadron-LA, Dexabliss, Dexacort PH Turbinaire, Dexacort Respihaler, DexPak Jr TaperPak, DexPak TaperPak, Dextenza, DEXYCU, DoubleDex, Dxevo, Hemady, HiDex, Maxidex, Ocu-Dex , Ozurdex, ReadySharp Dexamethasone, Simplist Dexamethasone, Solurex, TaperDex, ZCORT, Zema-Pak, ZoDex, ZonaCort 11 Day, ZonaCort 7 Day
NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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