Spinal cord compression

In spinal cord compression, local or radicular pain is the most frequent and earliest clinical symptom. Clinical examination in the early stages can be unremarkable. However, subsequent weakness and bladder and bowel dysfunction can develop.

The diagnosis of spinal cord compression must always be considered even if the clinical examination is normal. The diagnosis can be confirmed by MRI, which is considered superior to CT imaging or myelography. Lumbar puncture should be avoided as herniation of the cord into a decompressed region can result following the removal of cerebrospinal fluid. Manometry and cytological analysis are unlikely to give diagnostic information and may worsen the situation due to the lumbar puncture.

Patients with rapidly progressive neurological signs should be considered for neurosurgical decompression, and radiotherapy is useful in the treatment of slowly progressive lesions. Systemic chemotherapy and corticosteroids should not be used in place of surgery or radiotherapy, and may not influence the clinical situation.