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Malignant spinal cord compression

Last reviewed: 4 Nov 2023
Last updated: 01 Nov 2023



History and exam

Key diagnostic factors

  • known cancer diagnosis
  • ≥40 years of age
  • back pain
  • weakness or paralysis
  • numbness or paresthesias
  • sensory loss
  • hyperreflexia and Babinski or associated reflexes
  • bladder or bowel dysfunction
More key diagnostic factors

Other diagnostic factors

  • cauda equina syndrome
  • Brown-Sequard syndrome
Other diagnostic factors

Risk factors

  • tumor type and metastases
  • immune system disorders
  • radiation exposure
  • genotype features
More risk factors

Diagnostic investigations

1st investigations to order

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

Investigations to consider

  • CT spine
  • x-ray
  • bone scintigraphy
  • positron emission tomography (PET)
  • tumor biopsy and histopathology
  • serum calcium
  • serum alkaline phosphatase
  • cancer-specific laboratory testing
  • cancer stem cell markers
More investigations to consider

Treatment algorithm


all patients



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.

Lisa M. Ruppert, MD

Associate Attending Physiatrist

Department of Neurology-Rehabilitation Medicine Service

Memorial Sloan Kettering Cancer Center

Assistant Professor

Department of Rehabilitation Medicine

Weill Cornell Medical Center

New York



LMR is an author of references cited in this topic.

Peer reviewers

Marcin Czyz, MD, PhD

Consultant Spine Neurosurgeon

Department of Neurosurgery

University Hospitals Birmingham NHS Trust




MC declares that he has no competing interests.

  • Differentials

    • Spinal epidural abscess
    • Osteoporotic spinal compression fracture
    • Intervertebral disk herniation/compression
    More Differentials
  • Guidelines

    • Spinal metastases and metastatic spinal cord compression
    • NCCN clinical practice guidelines in oncology: central nervous system cancers
    More Guidelines
  • Patient leaflets

    Spinal cord compression: what is it?

    Spinal cord compression: what treatments work?

    More Patient leaflets
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