Can occur as a result of spine trauma, vertebral compression fracture, intervertebral disk herniation, primary or metastatic spinal tumor, or infection.
The resulting spinal cord injury may be acute, subacute, or chronic and occurs due to direct cord damage, by compression and/or infiltration, or by compromise of the vascular supply to the cord.
Diagnosis is made by x-ray or MRI of the spine, but spinal cord injury may occur with no findings on imaging.
Acute spinal cord compression is a medical emergency that requires swift diagnosis and treatment to prevent irreversible spinal cord injury and long-term disability.
Treatment of acute spinal cord compression may include corticosteroids, surgery, or radiation therapy.
Spinal cord compression (SCC) results from processes that compress or displace arterial, venous, and cerebrospinal fluid spaces, as well as the cord itself. This can occur as a result of extrinsic causes and lesions, or intrinsic etiologies of the cord substance. Examples include trauma or tumor affecting the cord substance, and lesions that compromise cord function emanating from surrounding elements or vascular sources. The presenting symptoms are a result of spinal cord injury (SCI) or root dysfunction and include paresis, sensory changes or loss of sensation, sphincter dysfunction (urinary or anal), and erectile problems. Diagnosis is made by x-ray, CT, or MRI of the spine, but SCI due to SCC can occur with no findings on imaging, a situation termed SCI without roentgen abnormality (SCIWORA).
History and exam
Key diagnostic factors
- age group 16 to 30 years (trauma)
- age group 30 to 50 years (disk disease)
- age group 40 to 75 years (malignancy)
- acute onset and duration of symptoms
- chronic onset and duration of symptoms
- back pain
- numbness or paresthesias
- weakness or paralysis
- bladder or bowel dysfunction
- 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
Other diagnostic factors
- history of malignancy
- intravenous drug use
- loss of rectal sphincter reflex
- loss of appendicular reflexes
- local deformity of spine on palpation
- Brown-Sequard syndrome
- anterior cord syndrome
- posterior cord syndrome
- age between 16 and 30 years and male sex
- high-risk occupation
- high-risk recreational activities
- intravenous drug use
1st investigations to order
- MRI spine
- gadolinium-enhanced MRI spine
- plain spine x-ray
- CT spine
- CT myelography
Investigations to consider
- complete blood count with differential
- erythrocyte sedimentation rate and C-reactive protein
- blood or cerebrospinal fluid cultures
- tumor biopsy and histopathology
- urodynamic studies
- positive emission tomography (PET) scan of the spine
acute traumatic spinal cord injury
nontraumatic intervertebral disk compression (cauda equina syndrome)
malignant spinal cord compression
Kenneth F. Casey, MD, FACS
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.
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
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
Clinic of the General Hospital of CPLA
SH declares that he has no competing interests.
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