cord compression

Last edited 10/2020 and last reviewed 06/2021

Spinal cord compression is characterised by a combination of a progressive history of neurological deficit and a sensory level on examination.

This is a lesion that causes lower motor neurone signs at the level of the lesion and upper motor neurone lesions below that level.

It is a neurological emergency because:

• the final events are ischaemic, so they are fast and irreversible
• the patient may be left in a wheelchair, incontinent of urine

Note that the commonest cause of acute cord compression is metastatic disease.

• true incidence of metastatic spinal cord compression in England and Wales is unknown because cases are not systematically recorded. However, evidence from an audit carried out in Scotland between 1997 and 1999 and from a published study from Canada, suggests that the incidence may be up to 80 cases per million people every year. This equates to approximately 4000 cases each year in England and Wales, or more than 100 cases per cancer network each year
• metastatic spinal cord compression (MSCC) develops in 5%–10% of all cancer patients and in 40% of patients with preexisting nonspinal bone metastasis (2)
• treatments for patients with MSCC differ based on their life expectancies (3,4)
• to improve the quality of life, patients with a life expectancy of more than 3–6 months may undergo surgery (5,6)
• decompressive surgery which is considered to be the “gold standard” in tumors which are not specifically radiosensitive (7)
• evidence shows that survival of MSCC patients can be improved with palliative decompression before motor deficits occur. After motor deficit onset, survival can still be improved with surgery within 7 days. Overall survival was better in patients aged <=55 years (8)

Reference:

• 1. NICE (November 2008). Diagnosis and management of adults at risk of and with metastatic spinal cord compression.
• 2. Schmidt MH, Klimo P Jr, Vrionis FD. Metastatic Spinal Cord Compression. J Natl Compr Canc Netw. 2005. September;3(5):711–9
• 3.Mattana JL, Freitas RR, Mello GJ, Neto MA, Freitas Filho Gd, Ferreira CB, et al. Study on the applicability of the modified Tokuhashi score in patients with surgically treated vertebral metastasis. Rev Bras Ortop. 2015. November;46(4):424–30
• 4.Murakami H, Kawahara N, Demura S, Kato S, Yoshioka K, Sasagawa T, et al. Perioperative complications and prognosis for elderly patients with spinal metastases treated by surgical strategy. Orthopedics. 2010. March;33(3):165–8.
• 5. Lee CH, Kwon JW, Lee J, Hyun SJ, Kim KJ, Jahng TA, et al. Direct decompressive surgery followed by radiotherapy versus radiotherapy alone for metastatic epidural spinal cord compression: a meta-analysis. Spine (Phila Pa 1976). 2014. April;39(9):E587–92
• 6.Nemelc RM, Stadhouder A, van Royen BJ, Jiya TU. The outcome and survival of palliative surgery in thoraco-lumbar spinal metastases: contemporary retrospective cohort study. Eur Spine J. 2014. November;23(11):2272–8.
• 7. Klimo P, Kestle JRW, Schmidt MH. (2005) A meta-analysis of surgery versus conventional radiotherapy for the treatment of metastatic spinal epidural disease. Neuro Oncol. 2005;7:64–75.
• 8. Lo W-Y. Metastatic spinal cord compression (MSCC) treated with palliative decompression: Surgical timing and survival rate. PLoS 2017; 12(12): e0190342.