Clinical features

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

Reference:

• NICE (September 2023). Spinal metastases and metastatic spinal cord compression