Spinal cord compression

Last reviewed: 31 Dec 2022
Last updated: 07 Aug 2019



History and exam

Key diagnostic factors

  • presence of risk factors
  • age group 16 to 30 years (trauma)
  • age group 30 to 50 years (disc disease)
  • age group 40 to 75 years (malignancy)
  • acute onset and duration of symptoms
  • chronic onset and duration of symptoms
  • back pain
  • numbness or paraesthesias
  • weakness or paralysis
  • bladder or bowel dysfunction
  • hyper-reflexia
  • sensory loss
  • muscle weakness or wasting
  • loss of tone below level of suspected injury (spinal shock)
  • hypotension and bradycardia (neurogenic shock)
  • complete cord transection syndrome
  • cauda equina syndrome
  • central cord syndrome
More key diagnostic factors

Other diagnostic factors

  • history of malignancy
  • immunosuppression
  • intravenous drug use
  • loss of rectal sphincter reflex
  • loss of appendicular reflexes
  • local deformity of spine on palpation
  • Brown-Sequard's syndrome
  • anterior cord syndrome
  • posterior cord syndrome
Other diagnostic factors

Risk factors

  • age between 16 and 30 years and male sex
  • trauma
  • tumour
  • osteoporosis
  • high-risk occupation
  • high-risk recreational activities
  • intravenous drug use
  • immunosuppression
More risk factors

Diagnostic investigations

1st investigations to order

  • MRI spine
  • gadolinium-enhanced MRI spine
  • plain spine x-ray
  • CT spine
  • CT myelography
More 1st investigations to order

Investigations to consider

  • full blood count with differential
  • erythrocyte sedimentation rate and C-reactive protein
  • blood or cerebrospinal fluid cultures
  • tumour biopsy and histopathology
  • urodynamic studies
  • positive emission tomography (PET) scan of the spine
More investigations to consider

Treatment algorithm


acute traumatic spinal cord injury

non-traumatic intervertebral disc compression (cauda equina syndrome)

malignant spinal cord compression

epidural abscess



Kenneth F. Casey, MD, FACS
Kenneth F. Casey

Clinical Associate Professor Surgery (Neurosurgery)

Michigan State University

Clinical Associate Professor (Physical Medicine and Rehabilitation)

Wayne State University School of Medicine




KFC declares that he has no competing interests.

Peer reviewers

Marc Chamberlain, MD

Professor of Neurology

Moffitt Cancer Center and Research Institute

University of Washington




MC is an author of several references cited in this topic.

Alexios G. Carayannopoulos, DO, MPH

Interventional Spine Physiatrist

Pain Medicine Specialist

Medical Director

Spine Center

Lahey Clinic




AGC declares that he has no competing interests.

William A. Petri, Jr, MD, PhD, FACP

Chief and Professor of Medicine

Division of Infectious Diseases and International Health

University of Virginia Health System




WAP declares that he has no competing interests.

Shuxun Hou, MD, PhD

Professor and Chief Physician

Orthopaedic Department

Clinic of the General Hospital of CPLA




SH declares that he has no competing interests.

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