Symptoms related to spinal cord compression vary and depend on the extent of the compression present. Mild compression may lead to a prickling or tingling sensation, backache, muscle weakness and erectile dysfunction. The painful sensation of the back may extend to the back of the leg and reflexes may be affected too, either in terms of weakened or exaggerated reflexes.

If the compressive cause is not removed or repaired, continual pressure exerted on the spine can lead to more severe symptoms, such as urinary retention or loss of bowel and bladder control, considerably weakened muscles and numbness. The most severe symptoms that can arise from SCC are paralysis and a complete loss of sensory function.

• Pain

  Extramedullary Intramedullary a)UMN signs Common Late b)LMN signs 1or2segments at the site of wide (Ant horn cell) root compression Motor Sensory a)Pain Root pain Funicular pain b)Dissociated sensory loss Absent present c)Sacral sensation Lost Preserved [slideshare.net]

  Several rare yet potentially devastating causes of acute back pain are deserving of consideration when approaching back pain in the ED setting; SSH is among them. [ncbi.nlm.nih.gov]

  PRESENTATION The most common presenting feature for spinal metastases is increasing back pain. The pain may be localised or generalised and is due to compression, pathological fractures, or axial pain from mechanical instability. [bjgp.org]

• Weakness

  Examination of the lower limbs demonstrated a wasted left leg with reduced muscle tone and MRC grade 3 weakness, compatible with the early history of polio. [academic.oup.com]

  […] signs and segmental sensory loss in the arms; upper motor neuron signs in the legs Respiratory (intercostal) weakness Thoracic Spastic paraplegia with a sensory level at the trunk Weakness of the legs, sacral loss of sensation and extensor (upward) plantar [dundeemedstudentnotes.wordpress.com]

  We present a case of an osteochondroma of the spine presenting with spinal cord compression. 27-year-old male presented with lower extremity weakness and paresthesia, decreased lower extremity sensation, and decreased proprioception. [ncbi.nlm.nih.gov]

  As we age, our bones become more brittle and weak, putting strain on the surrounding nerves. [intermountainhealthcare.org]

• Difficulty Walking

  Cervical myelopathy is a syndrome of difficulty walking, hand clumsiness, arm weakness, and/or numbness/tingling caused by compression of the spinal cord. [uncmedicalcenter.org]

  Spinal cord compression can cause neurologic symptoms—such as pain, numbness, or difficulty walking. Your spinal cord is the conduit that enables communication between your brain and body. [spineuniverse.com]

  New difficulty walking or climbing stairs; reduced power (motor weakness), Sensory impairment or altered sensation in limbs. Bowel or bladder disturbance; loss of sphincter control is a late sign with a poor prognosis. [palliativecareguidelines.scot.nhs.uk]

• Falling

  Patients with MESCC should receive surgery before the preoperative ASIA Impairment Scale grade falls below grade C. [ncbi.nlm.nih.gov]

  […] anatomy spinal cord cauda equina epidemiology number of different causes different patient groups for each pathology may affect all age groups presentation may be a mixed clinical picture back pain - red flags history of malignancy violent trauma: e.g. fall [radiopaedia.org]

  Falls. A spinal cord injury after age 65 is most often caused by a fall. Overall, falls cause about 31% of spinal cord injuries. Acts of violence. [mayoclinic.org]

  An injury to the neck—such as from a car accident, sports, or a fall—may also lead to myelopathy. [orthoinfo.aaos.org]

• Inflammation

  This process is called inflammation, and as the synovium becomes inflamed, you will feel pain and stiffness. Long-term inflammation in the cervical spine can destroy the facet joints. [verywellhealth.com]

  Steroid injections may help reduce inflammation relieving some of the compression. Occasionally steroids are injected around the nerves in the spinal column (epidural steroid injections – ESI) easing the pain and reducing the inflammation. [orlandoortho.com]

  Drugs like aspirin, ibuprofen, and naproxen can help relieve pain from reduce inflammation. Oral corticosteroids. A short course of oral corticosteroids may help relieve pain by reducing inflammation. Epidural steroid injection. [orthoinfo.aaos.org]

• Cough

  The most common symptoms in children with mediastinal GCTs, which are nonspecific, are dyspnea, chest pain, cough, hemoptysis, vena cava occlusion syndrome, and fatigue/weakness. [ncbi.nlm.nih.gov]

  Pain can also be reported, often aggravated through straining, such as coughing or sneezing. There will be bi- or unilateral weakness in most cases (around two thirds of MSCC patients are non-ambulatory at diagnosis). [teachmesurgery.com]

  Numbness, weakness or difficulty using the arms or legs Bladder or bowel control problems Pain or tenderness in the middle or top of the back or neck Severe pain in the lower back that is getting worse or doesn’t go away Pain in the back that is worse on coughing [rdehospital.nhs.uk]

• Dyspnea

  The most common symptoms in children with mediastinal GCTs, which are nonspecific, are dyspnea, chest pain, cough, hemoptysis, vena cava occlusion syndrome, and fatigue/weakness. [ncbi.nlm.nih.gov]

• Fecal Incontinence

  Spinal cord compression usually causes decreased sensation and paralysis of limbs below the level of compression, urinary and fecal incontinence, and/or urinary retention, which brings great suffering to the patients and usually requires surgical intervention [ncbi.nlm.nih.gov]

  Signs and symptoms[edit] Symptoms suggestive of cord compression are back pain, a dermatome of increased sensation, paralysis of limbs below the level of compression, decreased sensation below the level of compression, urinary and fecal incontinence and [en.wikipedia.org]

  He denies back pain or urinary or fecal incontinence. Regarding pain management, he had been recently treated at one of the pain clinics in the hospital and has continued on opioid medication at another institution. [mdedge.com]

  Other symptoms may occur: Reduced sexual response, including erectile dysfunction in men Retention of urine Loss of bladder control (urinary incontinence) Loss of bowel control (fecal incontinence) Loss of reflexes in the knee and ankle People who have [merckmanuals.com]

• Back Pain

  Several rare yet potentially devastating causes of acute back pain are deserving of consideration when approaching back pain in the ED setting; SSH is among them. [ncbi.nlm.nih.gov]

  Symptoms for MSCC include sensory changes, autonomic dysfunction, and back pain; however, back pain was not predictive of MSCC. [doi.org]

  It is important to note that radicular pain in the thoracic area is described as pain radiating around from back to front in a band-like distribution. This may be mistaken for epigastric or pleural pain. [cancernetwork.com]

  He denies back pain or urinary or fecal incontinence. Regarding pain management, he had been recently treated at one of the pain clinics in the hospital and has continued on opioid medication at another institution. [mdedge.com]

• Osteoporosis

  If the fracture is caused by osteoporosis, treatment of the osteoporosis can help prevent additional fractures. Treatment may include calcium and vitamin D supplements, bisphosphonates, and weight bearing exercises. [columbianeurosurgery.org]

  Vertebrae that are weakened by cancer or osteoporosis may break after a slight or even no injury. Connective tissue: Connective tissue that lines the spinal canal often enlarges and hardens as people age. [merckmanuals.com]

  Osteoporosis TB The most common cause of spinal cord compression in countries where TB is common There is destruction of both the disc and the vertebra Paralysis can occur – in which case it is called Pott’s Paraplegia Epidural abscess Vertebral neoplasms [almostadoctor.co.uk]

  Risk Factors for Spinal Cord Compression: excess weight: causing more stress of joints that are weight-bearing trauma – sports related, motor vehicle accidents use of poor lifting techniques medical conditions: osteoporosis, rheumatoid arthritis, osteoarthritis [orlandoortho.com]

• Osteophyte

  Axial computerized tomography scan showing ventral osteophytes pressing into the spinal canal. FIGURE 1. Axial computerized tomography scan showing ventral osteophytes pressing into the spinal canal. [aafp.org]

  Depending on the cause of the myelography, surgery may involve removing a herniated disc or bone spurs (osteophytes) to decompress the cord. Spine surgery to treat a myelopathy may include other procedures, such as laminectomy and fusion. [spineuniverse.com]

  It is commonly caused by Bony protrusions into the cervical, thoracic, or lumbar spinal canal (eg, due to osteophytes or spondylosis, especially when the spinal canal is narrow, as occurs in spinal stenosis) Compression can be aggravated by a herniated [merckmanuals.com]

• Low Back Pain

  We describe a case of EMH in a 21-year-old man with β-thalassemia intermedia presenting with progressive low back pain, worsening paraparesis and sphincter disturbance. [ncbi.nlm.nih.gov]

  CONTINUE SCROLLING OR CLICK HERE FOR RELATED SLIDESHOW QUESTION Nearly everyone has low back pain at some time during their life. See Answer [medicinenet.com]

  Computed tomography for the diagnosis of lumbar spinal pathology in adult patients with low back pain or sciatica: a diagnostic systematic review. Eur Spine J. 2012;21(2):228-39. (Level II evidence). [imagingpathways.health.wa.gov.au]

  back pain, it is the most common systemic disease affecting the spine.17 An important clinical inquiry is to determine whether back pain in an established cancer patient can be ruled out without extensive imaging. [mdedge.com]

• Muscle Weakness

  Mild spinal cord compression may cause only: Slight muscle weakness Tingling Severe compression may cause: Severe muscle weakness or complete paralysis Complete loss of sensation Inability to control your urine and bowel movements If you have cancer and [merckmanuals.com]

• Incontinence

  Spinal cord compression may cause pain, weakness, loss of feeling, paralysis, incontinence (inability to control urine or stool), or impotence (inability to have an erection of the penis). [cancer.gov]

  Spinal cord compression usually causes decreased sensation and paralysis of limbs below the level of compression, urinary and fecal incontinence, and/or urinary retention, which brings great suffering to the patients and usually requires surgical intervention [ncbi.nlm.nih.gov]

  Clinical features include bowel incontinence or constipation or urinary retention*. Additionally, there may also be evidence of the underlying cause, e.g. malignant features such as weight loss and tiredness. [teachmesurgery.com]

  Loss of bladder control results in urinary retention, frequent small voids, overflow or incontinence. Loss of bowel control such as the urge to defecate, may lead to constipation or incontinence. [healthengine.com.au]

• Urinary Retention

  Spinal cord compression usually causes decreased sensation and paralysis of limbs below the level of compression, urinary and fecal incontinence, and/or urinary retention, which brings great suffering to the patients and usually requires surgical intervention [ncbi.nlm.nih.gov]

  Clinical features include bowel incontinence or constipation or urinary retention*. Additionally, there may also be evidence of the underlying cause, e.g. malignant features such as weight loss and tiredness. [teachmesurgery.com]

  […] traffic accident (case 1) thoracic or radicular pain constant, progressive, non-mechanical pain systemically unwell widespread neurological signs and symptoms power reduction: 80% of patients need help to mobilize loss of sensation: saddle anesthesia urinary [radiopaedia.org]

  Retention Constipation Treatment It is a medical emergency Can be difficult to differentiate a chronic from an acute cause, particularly if pain and sensory level are ambiguous. [almostadoctor.co.uk]

• Urinary Incontinence

  Ten patients (48%) were not ambulatory before surgery and four suffered urinary incontinence/constipation (19%). Preoperative AIS was E in 5 patients (24%), D in 11 (62%), and C in 5 (24%). [ncbi.nlm.nih.gov]

  When urinary incontinence starts or when patients become dependent on a wheel chair for long period of time, the chance that surgery will help decreases. [spinedoctormiami.com]

  In general, clinical signs include paresis or paralysis, but depending on the level of the spinal cord involved and the type of lesion present there may also be urinary incontinence, loss of sensation, Horner's syndrome, and in acute lesions, spinal shock [medical-dictionary.thefreedictionary.com]

  Other symptoms may occur: Reduced sexual response, including erectile dysfunction in men Retention of urine Loss of bladder control (urinary incontinence) Loss of bowel control (fecal incontinence) Loss of reflexes in the knee and ankle People who have [merckmanuals.com]

• Overflow Incontinence

  There may be overflow incontinence when the bladder cannot physically hold any more urine. [neuroanatomy.wisc.edu]

• Myelopathy

  The ideal treatment, therefore, depends on the situation, and the most acute treatment possible is necessary in patients presenting with myelopathy. [ncbi.nlm.nih.gov]

• Tingling

  Mild compression may lead to a prickling or tingling sensation, backache, muscle weakness and erectile dysfunction. [symptoma.com]

  Cervical spinal stenosis may cause numbness or tingling sensations. [livestrong.com]

  Cervical myelopathy is a syndrome of difficulty walking, hand clumsiness, arm weakness, and/or numbness/tingling caused by compression of the spinal cord. [uncmedicalcenter.org]

• Hyperreflexia

  Physical examination revealed hyperreflexia and a T11 sensory level. MRI revealed a pseudomeningocele compressing the thoracic spinal cord. The patient underwent surgical drainage of the cyst. [ncbi.nlm.nih.gov]

  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. [merckmanuals.com]

  There will be upper motor neurone signs present (as opposed to the lower signs seen in peripheral nerve compression or cauda equina sydrome), including hypertonia, hyperreflexia*, Babinski’s sign, and clonus (present below the level of the lesion). [teachmesurgery.com]

  Lhermitte's sign (intermittent shooting electrical sensation) and hyperreflexia may be present. [en.wikipedia.org]

• Limb Weakness

  We report a 7-year-3-month-old girl who suffered from neck pain with restricted movement, poor appetite, body weight loss, mild right limbs weakness, and a non-tender neck mass. [ncbi.nlm.nih.gov]

• Paresthesia

  We present a case of an osteochondroma of the spine presenting with spinal cord compression. 27-year-old male presented with lower extremity weakness and paresthesia, decreased lower extremity sensation, and decreased proprioception. [ncbi.nlm.nih.gov]

  Sensory or motor symptoms that may be referred to the cord include limb paresthesias and weakness. [emedicine.medscape.com]

  The symptomatology (symptoms and signs) of spinal cord compression consists of sensory (pain, numbness and paresthesia), motor and autonomic disturbances, the nature and extend of which is related to: * the level that is compressed - high or low cervical [neuroanatomy.wisc.edu]

The suspicion of spinal cord compression must be followed by prompt workup, due to the devastating and potentially irreversible consequences of paralysis and sensory loss.

The first step towards a diagnosis includes a plain radiograph of the spinal column, in order to detect fractured vertebral bodies or a dislocation [7]. Following the radiographic imaging, a magnetic resonance imaging (MRI) scan is the test of choice in order to illustrate the spinal cord and its surrounding structures. Herniated discs, tumors, abscesses or hematomas can all be detected via MRI; if the procedure cannot be performed for lack of availability, a myelography can be done instead. A potential infection of the spinal tract can be ruled out via a lumbar puncture. In the case that a tumor is discovered, further evaluation including a biopsy will be required, in order to confirm malignancy [8].

Partial or acute spinal cord compression must be addressed at once; successful identification of the condition and proper treatment will relieve the spinal cord of the extreme pressure and sensory and/or motor function will be restored, since irreversible damage to the nerves requires time in order to develop. Surgical intervention is the treatment of choice in such cases.

Apart from surgery, SCC induced by other causes may require different types of treatment as well. Should a hematoma or tumor be the cause of SCC, dexamethasone or methylprednisolone may help to restore the amount of pressure exerted on the spinal cord [9]. Corticosteroids target the inflammation caused by the tumor and the latter can then be surgically excised or treated with radiation therapy [10] [11].

Abscesses can cause extra pressure to the spinal cord; if that is the cause, surgical excision is the method of choice, followed by the administration of antimicrobial agents [12]. In the absence of any neurological sequelae, the abscess open link may be solely drained, possibly followed by antibiotic coverage. Surgical drainage is also the method most doctors prefer in cases of hematomas. Should an individual suffer from a coagulation disorder, vitamin K injections and plasma transfusions are opted for, in order to reduce the risk of bleeding and hematoma recurrence.

With regard to the most common cause of SCC, trauma, only a small percentage of the patients are expected to experience a relapse, due to a certain instability of the spinal cord or because they do not refrain from the activity that caused the traumatic injury. 1/3 of the patients who experience loss of limb motion are expected to regain mobility and almost 80% of the individuals will require urinary catheterization for the rest of their lives [5].

SCC that is a result of malignancy is expected to reappear at a rate of up to 10% and when the condition arises due to cauda equina syndrome, recurrence is exhibited at a rate of up to 15% [6].

Spinal cord compression has multiple etiologic factors [2]. The most common cause is cancer, and particularly metastatic cancer usually originating from the lungs, brain, prostate or lymphatic tissue. A tumor that originally appears on the spine can also cause compression, but this is not usually observed in daily clinical practice. Another common cause is osteoporosis, which leads to frequent fractures of the skeleton; the dislocated bones can either lead to compression or exacerbate an already existing case of compression.

Secondarily, any mass or lesion in the vicinity of the spine can put pressure on the spinal cord. For these reasons, hematomas and abscesses pose a threat to the functionality of the spinal cord. Hematomas can arise as a result of anti-coagulant medications, arteriovenous malformations or congenital deficiency of clotting factors. Herniated discs can also press the spinal cord, as can any type of dysregulated growth of the skeleton, such as cervical spondylosis. Fibrosis of the connective tissue that envelopes the spinal cord can also restrain the cord itself and cause neurological symptoms due to compression.

Depending on the causes, spinal compression can either appear acutely and suddenly, or develop in a more gradual fashion over a longer period of time.

Spinal cord compression is a condition that is frequently diagnosed on an international level. Nevertheless, scarce data is available concerning its prevalence worldwide and the numbers presented here are estimations obtained from USA studies. According to these studies, the prevalence of SCC amounts to 4 per 100,000 individuals per year [3]. and the relative majority of the affected patients belong to the age group of 16 to 30 years old [4]. It is believed that the frequency of SCC has been on a steady rise during the past years, with trauma being the most common cause of acutely arising spinal cord compression.

Extending from the foramen magnum to the first two lumbar vertebrae, the spinal cord consists of grey and white matter, encased within a sac of three layers of meninges for reasons of protection. The innermost membrane is the pia mater and the middle membrane is the arachnoid mater; between the two, in the space called the subarachnoid space, the cerebrospinal fluid flows, providing minimal friction and additional protection to the spinal cord. On the external part of the dura, which is the outermost of the three meninges, the skeletal vertebral column encloses the spinal cord and the meninges.

At various levels in the route of the spinal cord, nerve roots serving both motor and sensory functions enter the structure, alongside vessels that provide the necessary perfusion. Any cause that leads to an increased amount of pressure to the cord, nerves and vessels can lead to neurological sequelae, such as tingling sensations, inability to feel temperature, abnormal pain sensations and even motor dysfunction and paralysis.

Acute spinal cord compression is most frequently caused by trauma or herniated discs. Fractured vertebral bodies and spinal subluxation can also lead to the same clinical picture. The condition can also arise in a more slow fashion, due to a tumor, degeneration or infection; these are the chronic types of SCC. Irrespective of the cause, the common denominator between both acute and chronic SCC is the loss of spinal cord and nerve root function. Any type of compressive injury to the vascular system responsible for the perfusion of the spinal cord also causes the same symptoms: the corticospinal and spinocerebellar tracts are the two most prone to compressive malfunction.

Concerning the occupations that are accompanied by an augmented risk of sustaining traumatic injuries of the spinal cord or disc herniation, adequate measures have to be taken by employers in order to educate the employees regarding self-protection and safe practice. Adequate safety measures should also be provided for by employers, such as restraint systems. Jobs with a such a higher risk include:

• Firefighters
• Military personnel
• Professional drivers
• People employed in the agriculture
• Seamen
• Construction workers

Any type of recreational activity that is organized should also abide by the same rules.

Compression of the spinal cord is a condition in which the spinal cord is subject to an abnormal amount of pressure.

The most common cause of spinal cord compression (SCC) is malignancy. In fact, 1 out of 20 cancer patients do exhibit this condition as a complication. Compression of the spine and, subsequently, spinal cord, is the second most common complication stemming from brain cancer [1]. There are two distinct pathways by which spinal cord compression induced by malignancy can occur. The first one involves a primary tumor of the spine, wherein the initial location of the cancerous tumor is on the spine itself, therefore exerting excessive pressure on the nervous tissue. A second pathway is metastatic cancer, wherein particularly malignancies of the lungs, prostate and breast have increased possibility of metastasizing to the spinal cord and pressing the nerves and roots. The first type of spinal cord compression, caused by a primary tumor of the spine, is termed malignant spinal cord compression and the latter is termed metastatic spinal cord compression.

Except for malignant causes, various other conditions can subject the spinal cord to increased pressure and related sequelae, including infectious diseases, spine trauma, hematomas, abscesses and osteoporotic damage.

The diagnosis of spinal cord compression can be achieved via a radiographic depiction of the spine, that will help to detect potential fractures, and a magnetic resonance imaging scan, that can delineate various tissue alterations in the vicinity of the spine, such as a hematoma, a tumor or a herniated disc. Treatment depends on the cause and may involve surgery, radiation therapy, chemotherapy or drainage. Treatment should be as prompt as possible, in order to prevent long-lasting pressure from being exerted on the spine, which will inadvertently lead to nerve damage that may be irreversible.

The spinal cord is a thin column that is made up of gray and white matter, exactly like the brain. It extends from the lower parts of the skull until the lumbar region and is encased in three membranes, a sac containing fluid and the spinal column, which consists of the vertebral skeleton. All three structures protect the vulnerable spinal cord from injuries, pressure and friction.

The spinal cord is a valuable organ, because it is responsible for sensory and motor functions. Nerves penetrate various locations of the organ and transmit vital information concerning movement and sensations (temperature, touch, pain, etc.). It should by all means be protected, because damage to it may be irreversible and can lead to devastating consequences and disability.

Various circumstances lead to an increased amount of pressure sustained by the spinal cord. Traumatic injuries, herniated discs, tumors, collections of pus or blood around the spinal region, as well as infection of the spine and fractured vertebrae can all lead to the condition known as spinal cord compression. Depending on the degree of compression, a person may experience strange tingling sensations, lose the ability to feel temperature or pain, feel numb and, in extreme cases, lose the ability to move and control their bladder and bowel.

The condition is diagnosed via X-rays of the back, and MRI or myelography and a lumbar puncture, if necessary. Treatment may be surgical or pharmacological and the results depend on the cause of the compression and the time that has passed between its development and the point of therapy.

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