Spinal cord compression is a medical emergency where the spinal cord is compressed, leading to neurological dysfunction.
Causes include traumatic injury, malignancy (primary or metastatic), infection (e.g., abscess), degenerative spinal disease, and herniated intervertebral discs.
Early recognition and treatment are crucial to prevent permanent neurological damage.
Pathophysiology
Compression of the spinal cord can result from extradural (outside the dura mater), intradural-extramedullary (within the dura but outside the cord), or intramedullary (within the cord) lesions.
This compression leads to ischemia and subsequent neuronal injury in the spinal cord.
The level of compression determines the clinical presentation and severity of symptoms.
Clinical Features
Pain localized to the level of spinal compression, often exacerbated by movement.
Neurological deficits depending on the level of compression: weakness, numbness, bladder and bowel dysfunction.
Upper motor neuron signs below the level of compression: hyperreflexia, spasticity, positive Babinski sign.
In cervical spine compression, all four limbs may be affected (quadriplegia), while in thoracic or lumbar compression, only lower limbs are involved (paraplegia).
Diagnosis
Clinical suspicion based on history and physical examination.
MRI is the imaging modality of choice for detailed visualization of the spinal cord and surrounding structures.
CT scan may be used if MRI is not available.
Additional investigations to identify the underlying cause (e.g., tumor markers, infection workup).
Management
Immediate referral to a specialist (neurosurgery or orthopedics) for surgical evaluation.
High-dose corticosteroids may be used acutely to reduce spinal cord edema (controversial due to potential side effects).
Surgical intervention (decompression laminectomy, removal of tumor/abscess) is often necessary.
Non-surgical management includes radiotherapy for certain tumors and antibiotics for infections.
Complications
Permanent neurological deficits, including paralysis and sensory loss.
Chronic pain.
Bladder and bowel dysfunction.
Secondary complications due to immobility (pressure sores, deep vein thrombosis).
Prognosis
Depends on the cause, level, and duration of compression, and the rapidity of intervention.
Early detection and treatment generally lead to better outcomes.
