Spinal Cord Compression
The spinal cord is a bundle of nerves, located within the bones of the spine (vertebrae), that sends messages from the brain to other parts of the body. Spinal cord compression occurs when there is pressure on an area of the spinal cord. This is most often caused by cancer cells that have spread to the bones around the spinal cord (vertebrae), but can also be caused by a tumor in the area of the spinal cord.
Spinal cord compression is considered an "oncologic emergency,” which is an acute health problem caused by the cancer itself or its treatment. Oncologic emergencies require immediate treatment.
When cancer cells spread to the vertebrae, they cause damage to these bones. As this new area of cancer grows, it can cause swelling in the area or cause the vertebrae to collapse, putting pressure on the spinal cord. This pressure can interrupt blood flow and cause damage to the nerves.
Certain cancers are more likely to spread to bone than others. The cancers that most commonly spread to the bone are prostate, breast, lung, thyroid, multiple myeloma and kidney.
When to notify your healthcare provider
A spinal cord compression is an emergency that must be treated quickly. Common signs of spinal cord compression to report to your healthcare provider right away include:
- Any new or worsening back pain. This pain can be in multiple areas and can radiate to areas away from the spinal cord. Lying down can often make the pain worse.
- Weakness or a feeling of your legs being "heavy.”
- Loss of bowel or bladder control – this can be incontinence or an inability to urinate or have a bowel movement.
If your healthcare provider suspects a spinal cord compression, they will do a physical and neurological exam to evaluate the symptoms. They may order imaging tests such as a CT scan or MRI to confirm the diagnosis, determine exactly where the tumor is located, and the extent of the compression.
How is spinal cord compression treated?
If spinal cord compression is diagnosed, treatment will be given to relieve the pressure on the spinal cord. Treatments must begin quickly to reduce the chance that the symptoms will become permanent.
The initial treatment typically includes corticosteroids, such as dexamethasone, and/or radiation therapy, with the goal of reducing the compression and relieving pain and other symptoms. Corticosteroids are used to quickly reduce swelling and pressure on the spinal cord. Radiation therapy targets the area of the cancer cells and can be given in as little as 1-5 doses, in many cases. In some cases, surgery may be used to remove an area of cancer or to stabilize the damaged vertebrae.
Once the immediate danger of the compression is treated, further treatments may be given to treat the underlying cancer, including chemotherapy, hormone therapy, and bisphosphonates (a type of medication used to reduce the risk of fracture caused by bone metastases).
Resources for further reading:
Malignant spinal cord compression from Macmillan Cancer Support