Spinal cord compression

The spinal cord is a column of nerve tissue that runs down the back from the brain stem. It runs through the centre of the vertebrae, which are the bones of the spine that protect the spinal cord. Nerves extend out from the spinal cord, in between the vertebrae, to different parts of the body. The nerves and spinal cord carry messages (electrical signals) between the brain and the rest of the body.

Spinal cord compression is a problem that occurs when something, such as a tumour, puts pressure on the spinal cord. This causes swelling and means that less blood can reach the spinal cord and nerves. As a result, the nerves and spinal cord don't get enough oxygen and can be permanently damaged.

Spinal cord compression is a serious condition that needs to be treated as soon as possible.

Spinal cord compression can be caused by any condition that puts pressure on the spinal cord.

In rare cases, a tumour can develop on the spine and cause spinal cord compression. But the most common cause of spinal cord compression in people with cancer is metastasis to the spine. Any type of cancer can spread to the spine, but it is most common with the following types:

• prostate cancer
• breast cancer
• lung cancer
• kidney cancer
• bone or soft tissue sarcoma
• Hodgkin or non-Hodgkin lymphoma
• multiple myeloma

Cancer usually spreads to the middle of the back (called the thoracic spine). It can also spread to the lower back (called the lumbar spine) or upper back and neck (called the cervical spine), but this doesn't happen as often.

Spinal cord compression can also be caused by:

• bone that doesn't grow or heal normally (for example, bone spurs or scoliosis)
• damage to or collapse of a vertebrae (for example, trauma from a car accident)
• an abscess (a sac filled with pus) around the spinal cord
• a hematoma around the spinal cord
• stiffening and inflammation of the tissue around the spinal cord (for example, rheumatoid arthritis)
• a ruptured or herniated disc

Symptoms of spinal cord compression depend on the part of the spine that is compressed and which nerves are affected. The symptoms may be mild at first, but can worsen or become more serious as more pressure is put on the spinal cord.

About 95% of people with spinal cord compression have pain in the back or neck. It may feel like a band around the chest or abdomen, and the pain can spread out (radiate) into the lower back, buttocks or legs. It may also spread down the arms. The pain may get worse when you lie down.

Other symptoms of spinal cord compression include:

• numbness, tingling or cramps in the fingers, toes or buttocks
• a burning sensation in the arms or legs (called sciatica)
• feeling unsteady or difficulty walking
• muscle weakness
• difficulty urinating
• incontinence
• constipation
• erectile dysfunction
• paralysis

Your healthcare team will try to find the cause of spinal cord compression. They will do physical and neurological exams that include questions and tests to check how well the brain, spinal cord, nerves and muscles are working. They will also check your coordination and reflexes.

The following imaging tests are used to diagnose spinal cord compression:

• MRI
• CT scan
• an x-ray of the spinal cord and spinal column (called myelography)

Spinal cord compression needs to be treated as soon as possible. The goal of treatment is to relieve pressure on the spinal cord and give you the best quality of life possible. Treatments are used to:

• relieve pain and other symptoms
• protect the nerves so normal body functions (such as bowel movements, bladder control or walking) aren't affected
• prevent more permanent damage to the spinal cord

External radiation therapy is the most common treatment for spinal cord compression caused by cancer. It uses a machine outside the body to direct a beam of radiation through the skin to a tumour. The radiation shrinks the tumour so it doesn't press on the spinal cord.

You will start external radiation therapy as soon as possible after your healthcare team diagnoses spinal cord compression. Treatment is usually short. It can vary from one treatment in total to daily treatments for up to 2 weeks. Some cancer types may require more treatments. For example, if you have Hodgkin lymphoma, non-Hodgkin lymphoma or multiple myeloma, you may need radiation therapy for up to 4 weeks. If you need surgery to treat cancer or spinal cord compression, radiation therapy may be given after surgery.

Surgery to treat spinal cord compression is becoming more common, especially to manage spinal instability (when the individual vertebrae move more than normal). Whether you can have surgery depends on several factors, including the type of tumour, where the tumour is, how unstable the spine may be and the prognosis of your cancer. Surgery to remove a tumour on the spinal cord also requires special equipment and a trained neurosurgeon or spinal surgeon, which may not be available at all treatment centres.

Surgery is used to remove as much of the tumour as possible. It is also used to stabilize the spine and relieve pressure within the spine.

The neurosurgeon or spinal surgeon may remove parts of the vertebrae to remove a tumour or relieve pressure on the spinal cord. Removing parts of a vertebra does not weaken the spine. The surgeon may then place steel pins or rods in the spine to help stabilize it.

Surgery may also be done to drain pus from an abscess or blood from a hematoma that is causing spinal cord compression. If abnormal bone growth or healing causes spinal cord compression, surgery may be used to correct these issues.

Your healthcare team may use drug therapy to treat a tumour that is causing spinal cord compression. The type of drugs given will depend on the type of cancer and if it started on or spread to the spinal cord.

Chemotherapy may be used for certain types of cancer, such as non-Hodgkin lymphoma or lung cancer. Hormone therapy and chemotherapy may be given after radiation therapy or surgery for other types of cancer, such as breast or prostate cancer.

Find out more about chemotherapy and hormone therapy.

Supportive drugs are given to lessen the harmful side effects of cancer treatment, rather than to treat the cancer itself. These drugs protect certain cells or organs. Supportive drugs are also called protective drugs.

The following supportive drugs may be used to prevent or treat spinal cord compression.

Corticosteroids are drugs that reduce swelling and lower the body's immune response. They are used to quickly lower swelling around and pressure on the spinal cord. They can also quickly relieve pain.

You will usually be given corticosteroids right away if your healthcare team thinks you have spinal cord compression. If symptoms improve or you start other treatments, the dose of corticosteroids will gradually be lowered and stopped.

If your healthcare team thinks you are at risk of developing spinal cord compression, they may prescribe bisphosphonates. These drugs stop the body from breaking down bone and help strengthen bones. Bisphosphonates are used to help protect bones in the spinal column against the effects of some cancers.

Find out more about bisphosphonates.