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Spinal cord compression — Clinical Guidelines

Overview

Spinal cord compression occurs when structural abnormalities or masses compress the spinal cord, leading to neurological deficits ranging from pain and weakness to paralysis. It can result from various etiologies including epidural hematomas, tumors, disc herniations, and vascular malformations 1 3 6 10 11.

Diagnosis

Clinical Presentation: Neurological deficits such as weakness, sensory loss, and bowel/bladder dysfunction 3 7 17.

Imaging: MRI is crucial for identifying the degree of compression and distinguishing compressive from noncompressive causes 3 6 10.

Grading: Assessment often involves evaluating the extent of spinal cord edema and signal changes on MRI T2-weighted images 3.

Management

Surgical Decompression: Indicated for compressive lesions causing significant neurological deficits 1 6 18.

Medical Management: Steroids for acute inflammatory response (e.g., dexamethasone) 13.

Pain Control: Morphine for severe pain, with caution to avoid respiratory depression 15.

Adjunctive Therapies: Intrathecal baclofen for muscle spasms 16.

Special Populations

Pediatrics: Rare cases reported, such as lumbar epidural varicose veins in adolescents 1.

Elderly: Increased risk of complications from surgery and anesthesia; careful consideration of comorbidities 7.

Comorbidities: Cervical lesions require meticulous management to avoid exacerbating neurological deficits 9.

Key Recommendations

Immediate MRI Evaluation: For suspected spinal cord compression to differentiate compressive from noncompressive causes (Evidence: Strong 3).

Surgical Intervention for Severe Cases: Decompressive surgery is recommended for significant neurological deficits due to compressive lesions (Evidence: Moderate 1 6).

Use of Steroids: Administer high-dose corticosteroids early in the course of malignant cord compression to reduce inflammation (Evidence: Moderate 13).

Awake Fiberoptic Intubation: For cervical lesions to minimize neurological risk during anesthesia (Evidence: Expert opinion 9).

Monitor for Postoperative Complications: Particularly with materials like DuraSeal, which may cause delayed cord compression (Evidence: Weak 10).

References

1 Kerolus MG, Kramer DE, Turel MK, Malik R, Fessler RG, Chen M. Preoperative Transvenous Liquid Embolization for a Symptomatic Lumbar Spinal Epidural Varix Mimicking Radiculopathy. Neurology India 2022. link 2 Kimura S, Nakata K, Sube A, Kuniya T, Watanabe N, Yonemaru K et al.. Encapsulated gas accumulation in the spinal canal: Pneumorrhachis in two dogs. The Journal of veterinary medical science 2020. link 3 Laur O, Nandu H, Titelbaum DS, Nunez DB, Khurana B. Nontraumatic Spinal Cord Compression: MRI Primer for Emergency Department Radiologists. Radiographics : a review publication of the Radiological Society of North America, Inc 2019. link 4 Driver CJ, Rose J, Tauro A, Fernandes R, Rusbridge C. Magnetic resonance image findings in pug dogs with thoracolumbar myelopathy and concurrent caudal articular process dysplasia. BMC veterinary research 2019. link 5 Senneca C, Garcia G, Rosenberg JF, Heard D, Porter E, Olivera L et al.. ACUTE NONCOMPRESSIVE NUCLEUS PULPOSUS EXTRUSION CAUSING PARAPLEGIA IN A SIBERIAN TIGER ( PANTHERA TIGRIS ALTAICA). Journal of zoo and wildlife medicine : official publication of the American Association of Zoo Veterinarians 2018. link 6 Celik H, Erdem Y, Karatay M, Yorubulut M, Gursoy T, Sertbas I et al.. Lumbar Epidural Varicose Vein: Early Neurological Improvement and Late Radiological Full Recovery with Surgery; The Importance of Magnetic Resonance Imaging in Follow-Up. Turkish neurosurgery 2015. link 7 George R. Back pain with lower limb paresis - a case study. Australian family physician 2012. link 8 Kitagawa M, Okada M, Kanayama K, Sakai T. Identification of ventrolateral intramedullary intervertebral disc herniation in a dog. Journal of the South African Veterinary Association 2012. link 9 Sriganesh K, Ramesh VJ, Veena S, Chandramouli BA. Dexmedetomidine for awake fibreoptic intubation and awake self-positioning in a patient with a critically located cervical lesion for surgical removal of infra-tentorial tumour. Anaesthesia 2010. link 10 Thavarajah D, De Lacy P, Hussain R, Redfern RM. Postoperative cervical cord compression induced by hydrogel (DuraSeal): a possible complication. Spine 2010. link 11 Dam-Hieu P, Magro E, Seizeur R, Simon A, Quinio B. Cervical cord compression due to delayed scarring around epidural electrodes used in spinal cord stimulation. Journal of neurosurgery. Spine 2010. link 12 Allan L, Baker L, Dewar J, Eljamel S, Grant RM, Houston JG et al.. Suspected malignant cord compression - improving time to diagnosis via a 'hotline': a prospective audit. British journal of cancer 2009. link 13 Loblaw DA, Holden L, Xenocostas A, Chen E, Chander S, Cooper P et al.. Functional and pharmacokinetic outcomes after a single intravenous infusion of recombinant human erythropoietin in patients with malignant extradural spinal cord compression. Clinical oncology (Royal College of Radiologists (Great Britain)) 2007. link 14 Conway R, Graham J, Kidd J, Levack P. What happens to people after malignant cord compression? Survival, function, quality of life, emotional well-being and place of care 1 month after diagnosis. Clinical oncology (Royal College of Radiologists (Great Britain)) 2007. link 15 Quevedo F, Walsh D. Morphine-induced ventilatory failure after spinal cord compression. Journal of pain and symptom management 1999. link00075-5) 16 Thompson E, Hicks F. Intrathecal baclofen and homeopathy for the treatment of painful muscle spasms associated with malignant spinal cord compression. Palliative medicine 1998. link 17 Jaradeh S. Cauda equina syndrome: a neurologist's perspective. Regional anesthesia 1993. link 18 Dickman CA, Zabramski JM, Sonntag VK, Coons S. Myelopathy due to epidural varicose veins of the cervicothoracic junction. Case report. Journal of neurosurgery 1988. link 19 Hirlekar G. Paraplegia after epidural analgesia associated with an extradural spinal tumour. Anaesthesia 1980. link

Spinal cord compression