Spinal cord compression

The spinal cord is a column of nerve tissue. It runs from the brain stem down the back through the centre of the vertebrae, which are the bones of the spinal column. The nerves in the spinal cord carry messages (electrical signals) between the brain and the rest of the body. Spinal cord compression (also called cord compression) is a problem that occurs when something, such as a tumour, puts pressure on the spinal cord. The pressure causes swelling and means that less blood can reach the spinal cord and nerves.

Spinal cord compression is a serious condition that needs to be treated right away.

Spinal cord compression can be caused by any condition that puts pressure on the spinal cord. It can happen if the vertebrae are damaged or collapse. It can also develop if a tumour puts pressure on the spinal cord.

The most common cause of spinal cord compression in people with cancer is metastasis to the spine. About 60%–70% of metastases to the spine occur in the middle part of the back, which is called the thoracic spine. About 20%–30% of metastases happen in the lower back, or lumbosacral spine. Only about 10% of metastases happen in the upper back or neck area, which is called the cervical spine. About 30% of people with metastasis to the spine will have metastases in more than one area of the spine.

Any type of cancer can spread to the spine, but it is more common with the following cancers:

• breast cancer
• lung cancer
• prostate cancer
• kidney cancer
• lymphoma
• multiple myeloma

Symptoms of spinal cord compression can vary. They may be mild at first or pain may be the only symptom. As the tumour puts more pressure on the spine, the symptoms become worse and more serious.

Pain in the back or neck is a common symptom. It may feel like a band around the chest or abdomen. It can radiate, or spread out, over the lower back and into the buttocks or legs. It may also spread down the arms. The pain may be worse when you lie down.

Other symptoms of spinal cord compression include:

• numbness in the toes or fingers, or over the buttocks
• feeling unsteady on your feet or difficulty walking
• passing very little urine or being unable to urinate
• loss of bladder or bowel control, which is called incontinence
• constipation

Your doctor will try to find the cause of spinal cord compression. This usually includes physical and neurological exams that include questions and tests to check brain, spinal cord and nerve function. Your doctor will also check your coordination and how well your muscles and reflexes are working.

Spinal cord compression is usually diagnosed by the following imaging tests:

• MRI
• CT scan

If a centre doesn’t have MRI or CT scans, the doctor may order myelography. During this procedure, an x-ray is taken after injecting a dye into the spinal canal. The spinal canal is the hollow space in the spinal column that contains the spinal cord.

Find out more about these tests and procedures.

Spinal cord compression needs to be treated right away to try to prevent permanent damage to the spinal cord. The goal of treatment is to 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, are not affected
• prevent permanent disability

You may be given one or more of the following treatments. Your doctor may also order physical therapy or other rehabilitation after treatment to help you maintain and improve your ability to move.

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

The healthcare team will usually start corticosteroids right away if they think you have cord compression. The dose is gradually lowered and then stopped if symptoms improve or if you start other treatments.

External beam radiation therapy is the most common treatment for spinal cord compression. It is a type of radiation therapy that uses a machine outside the body to direct radiation at a tumour and surrounding tissue. It is used to shrink a tumour pressing on the spinal cord.

You will start external beam radiation therapy as soon as possible after your doctor diagnoses cord compression. It is usually given as a short-course treatment, which means it is given for a short period of time. Treatments for most types of tumours can vary from a single treatment to daily treatments for 2 weeks. If you have lymphoma or multiple myeloma, you may need radiation therapy for up to 4 weeks. If you need surgery, radiation therapy may be given after surgery.

Surgery may be offered if the tumour doesn’t respond to radiation therapy or if you already had radiation therapy. But surgery is an option for only a small number of people. Whether or not you can have surgery depends on the type of tumour, where the tumour is and how unstable the spine may be. Other factors include whether or not the specialized equipment and a trained neurosurgeon are available in your area and the overall prognosis of the cancer.

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

Your healthcare team may use drug therapy to treat the tumour. The type of drugs given will depend on the type of cancer. Chemotherapy may be used for certain types of cancer such as non-Hodgkin lymphoma (NHL) or lung cancer. Hormonal therapy and chemotherapy may be given after radiation therapy or surgery for other types of cancer such as breast or prostate cancer.

If your healthcare team thinks that you are at risk of developing spinal cord compression, they may prescribe bisphosphonates. These drugs stop the body from breaking down bone. They also 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.