Spinal Cord Compression

What is Spinal Compression?

Spinal cord compression occurs when any mass or condition puts pressure upon the spinal cord. This mass may include a tumor, hematoma, calcification of ligament, or a bony enlargement. The

spinal cord has nerves that provide signals back and forth between your brain and the rest of your body ¹.

The spinal cord travels down from the back and protected by a series of bones called vertebrae that help to keep your body become straight. This compression can develop anywhere from the neck to the lower back. Depending on the cause and location of the compression, symptoms may develop suddenly or gradually.

Causes and risk-factors of Spinal Compression

Spinal cord compression usually develops in older-aged peoples (over 50 years). However, weakened bones gradually observed in patients with bone cancer (55%) or osteoporosis (60%) which may suddenly result in fracture and cause compression ². The causes of spinal compression include:

• Osteoarthritis
• Abnormal spine alignment (scoliosis)
• A ruptured or herniated disc
• Injury to the spine or vertebra
• Ossification of the ligament
• Calcification of ligament
• Spinal tumor
• Certain bone diseases
• Infection

Symptoms of Spinal Compression

The symptoms of spinal cord compression depend on the severity and the location of the compression. Symptoms can develop immediately or slowly, depending on the cause ³. These include:

• Severe pain and weakness in the neck or lower back
• Burning pain that radiates to the arms, buttocks, or legs (sciatica)
• Numbness, or cramping in the arms, thighs, or legs
• Loss of sensation in the feet
• Trouble with hand coordination
• Difficult walking or standing
• Weakness in a foot that causes a limp, called “Foot drop”
• Loss of bowel or bladder control

Diagnosis of Spinal Compression

The initial diagnosis involves the history and physical examination of patients by the physicians. Further tests that help with a diagnosis may include:

• X-rays of the spine;
• Computed tomography (CT) scan;
• Magnetic resonance imaging (MRI); and
• Electromyography (EMG): An electrical test of muscle activity;

Treatment of Spinal Compression

Treatment of spinal cord compression depends on the cause and symptoms of the patients. The medical team should comprise arthritis specialists, bone surgeons, nerve specialists, and physical therapists while treating spinal cord compression. The treatment protocol includes ⁴:

• Medications: Medicines may include nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain and swelling.
• Physical therapy: It includes exercises to strengthen the back, abdominal, and leg muscles.
• Corticosteroid injections: Intravenous corticosteroid (such as dexamethasone) injection helps to reduce swelling and pressure on the spinal cord.
• Surgery: This involves removing bone spurs and repairing fractured vertebrae. The fusion of vertebrae together may help to stabilize the patient’s back ⁵.
• Radiation therapy: Radiation therapy (with or without surgery) shows effectiveness in removing the tumor.
• Acupuncture and chiropractic care show their effectiveness sometimes.

Prevention of Spinal Compression

Though we can’t prevent all cases of spinal cord compression, but some strategies can reduce the risk of compression. These include:

• Maintaining a healthy body weight;
• Get regular exercise to keep your spine flexible;
• Regular lifting of weight;
• Maintaining a good posture; etc.

References

1. Ropper AE, Ropper AH. Acute spinal cord compression. New England Journal of Medicine. 2017;376(14):1358–1369. doi:10.1056/NEJMra1516539
2. Rades D, Schild SE. Spinal cord compression. European Journal of Cancer, Supplement. 2007;5(5):359–370. doi:10.1016/S1359-6349(07)70064-2
3. Zhou Y, Chai X, Zheng H, Song R, Qin X. Spinal cord compression syndrome caused by intraspinal epidural fibrous cord. Medicine (United States). 2017;96(33). doi:10.1097/MD.0000000000007592
4. Johnston RA. The management of acute spinal cord compression. Journal of Neurology, Neurosurgery and Psychiatry. 1993;56(10):1046–1054. doi:10.1136/jnnp.56.10.1046
5. Kawano O, Ueta T, Shiba K, Iwamoto Y. Outcome of decompression surgery for cervical spinal cord injury without bone and disc injury in patients with spinal cord compression: A multicenter prospective study. Spinal Cord. 2010;48(7):548–553. doi:10.1038/sc.2009.179