Spinal Cord Compression (SCC)
Spinal Cord Compression (SCC)
Spinal cord compression (SCC) occurs when pressure is applied to the spinal cord by various causes, leading to impaired nerve function. This pressure can develop suddenly or gradually and affects the transmission of signals between the brain and the rest of the body, causing a range of neurological symptoms.
Causes
- Extrinsic masses (most common):
- Metastatic tumors (from lung, breast, prostate, thyroid, kidney cancers, lymphoma, multiple myeloma)
- Primary bone tumors
- Epidural abscess or hematoma
- Herniated intervertebral discs
- Vertebral fractures or dislocations (trauma)
- Degenerative changes (osteophytes, spondylosis, spinal stenosis)
- Connective tissue hypertrophy (ligamentum flavum thickening)
- Infectious causes (vertebral osteomyelitis, discitis, tuberculosis, fungal infections)
- Rheumatoid arthritis causing atlantoaxial subluxation
- Intrinsic lesions (less common):
- Intramedullary tumors or arteriovenous malformations
Onset and Types
- Acute: Minutes to hours; often trauma, hematoma, or acute disc herniation.
- Subacute: Days to weeks; usually metastatic tumors, abscesses, or slowly expanding hematomas.
- Chronic: Months to years; typically degenerative changes, slow-growing tumors, or spinal stenosis.
Symptoms
- Early: Localized back pain, often radiating along nerve roots (radicular pain), tenderness over spine.
- Neurological deficits:
- Sensory loss (often starts in sacral dermatomes)
- Weakness or paralysis (paraparesis or quadriparesis)
- Reflex changes (initial hyporeflexia in acute cases, progressing to hyperreflexia)
- Positive Babinski (extensor plantar) reflex
- Loss of bowel and bladder control (sphincter dysfunction)
- Other signs: Spinal percussion tenderness (especially with metastatic disease, abscess, hematoma)
- In acute cases: Rapid progression to complete loss of function may occur due to spinal cord infarction.
Diagnosis
- Magnetic Resonance Imaging (MRI): Gold standard for detecting spinal cord compression, identifying lesion location, and assessing cord edema or infarction.
- Other imaging: CT scan, X-rays for bony abnormalities or fractures.
- Clinical examination: Neurological assessment to evaluate motor, sensory, reflex, and autonomic function.
Treatment
- Emergency management: High-dose corticosteroids (e.g., dexamethasone) to reduce spinal cord swelling and inflammation.
- Surgical decompression: Urgently indicated in cases of acute compression, progressive neurological deficits, or spinal instability.
- Radiation therapy: Often used for metastatic tumors causing compression, either alone or post-surgery.
- Antibiotics: For infectious causes like abscesses.
- Supportive care: Pain management, physical therapy, and bladder/bowel care.
Prognosis
- Depends on cause, severity, and rapidity of intervention. Early diagnosis and treatment improve neurological recovery and quality of life.
- Delayed treatment increases risk of permanent paralysis and disability.
Summary Table
| Aspect | Details |
|---|---|
| Causes | Metastatic tumors, trauma, herniated discs, infections, degenerative spine disease, hematoma |
| Onset | Acute (minutes-hours), subacute (days-weeks), chronic (months-years) |
| Symptoms | Back pain, radicular pain, sensory loss, weakness, reflex changes, bowel/bladder dysfunction |
| Diagnosis | MRI (gold standard), CT, neurological exam |
| Treatment | Corticosteroids, surgical decompression, radiation, antibiotics, supportive care |
| Prognosis | Better with early treatment; risk of permanent deficits if delayed |
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References
- Johns Hopkins Medicine. Spinal Cord Compression.
https://www.hopkinsmedicine.org/health/conditions-and-diseases/spinal-cord-compression - MSD Manuals. Spinal Cord Compression – Neurologic Disorders.
https://www.msdmanuals.com/professional/neurologic-disorders/spinal-cord-disorders/spinal-cord-compression - Cancer Research UK. Spinal Cord Compression.
https://www.cancerresearchuk.org/about-cancer/coping/physically/spinal-cord-compression/about - University of Rochester Medical Center. Spinal Cord Compression.
https://www.urmc.rochester.edu/encyclopedia/content?ContentTypeID=134&ContentID=13 - MSD Manuals. Compression of the Spinal Cord.
https://www.msdmanuals.com/home/brain-spinal-cord-and-nerve-disorders/spinal-cord-disorders/compression-of-the-spinal-cord - Patient.info. Spinal Cord Compression.
https://patient.info/doctor/spinal-cord-compression - TeachMeSurgery. Spinal Cord Compression.
https://teachmesurgery.com/neurosurgery/spinal/spinal-cord-compression/ - NCBI Bookshelf. Spinal Cord Compression.
https://www.ncbi.nlm.nih.gov/books/NBK557604/
Spinal cord compression is a medical emergency requiring prompt diagnosis and treatment to prevent permanent neurological damage. Causes vary from trauma to tumors and infections, with symptoms ranging from pain to paralysis. MRI is essential for diagnosis, and treatment includes steroids, surgery, radiation, and antibiotics depending on the cause.
