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Clinical features

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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The presentation of a spinal cord compression depends upon:

  • site of lesion - intramedullary lesions produce within spinal segmental damage only; others produce cord both root and segmental damage
  • extent of lesion - partial, e.g. Brown Sequard, or complete
  • level of lesion - roots only damaged below L1
  • speed of onset - rapidly progressive lesions usually produce permanent deficits
  • 'spinal shock' - upper motor neurone disease - but with a flaccid paralysis, loss of reflexes, absent plantar reflexes

Pain characteristics suggesting spinal metastases (1):

  • severe unremitting back pain
  • progressive back pain
  • mechanical pain (aggravated by standing, sitting or moving)
  • back pain aggravated by straining (for example, coughing, sneezing or bowel movements)
  • night-time back pain disturbing sleep
  • localised tenderness
  • claudication (muscle pain or cramping in the legs when walking or exercising)

Symptoms and signs suggesting cord compression (1):

  • bladder or bowel dysfunction
  • gait disturbance or difficulty walking
  • limb weakness
  • neurological signs of spinal cord or cauda equina compression
  • numbness, paraesthesia or sensory loss
  • radicular pain


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