Spinal cord compression (non-traumatic) - Revision history

Danbot: Strip excess bold

2026-03-22T09:26:54Z

Strip excess bold

← Revisión anterior		Revisión del 09:26 22 mar 2026
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	==Etiology==		==Etiology==
	*'''Malignancy''': lung, breast, prostate, renal cell, lymphoma, multiple myeloma		*'''Malignancy''': lung, breast, prostate, renal cell, lymphoma, multiple myeloma
	*~~'''~~[[Epidural abscess]]~~'''~~: hematogenous spread or direct extension; risk factors include IVDU, immunosuppression, recent spinal procedure		*[[Epidural abscess]]: hematogenous spread or direct extension; risk factors include IVDU, immunosuppression, recent spinal procedure
	*~~'''~~Epidural hematoma~~'''~~: anticoagulation, post-procedural, coagulopathy		*Epidural hematoma: anticoagulation, post-procedural, coagulopathy
	*~~'''~~Disc herniation~~'''~~: central disc causing cord compression (thoracic or cervical)		*Disc herniation: central disc causing cord compression (thoracic or cervical)
	*Degenerative spinal stenosis with myelopathy		*Degenerative spinal stenosis with myelopathy
	*Vertebral compression fracture (osteoporotic or pathologic)		*Vertebral compression fracture (osteoporotic or pathologic)

	==Clinical Features==		==Clinical Features==
	*~~'''~~Back pain~~'''~~ (present in >90% of malignant cases) — often worse at night, worse supine		*Back pain (present in >90% of malignant cases) — often worse at night, worse supine
	*~~'''~~Progressive weakness~~'''~~ (upper motor neuron signs below level of compression)		*Progressive weakness (upper motor neuron signs below level of compression)
	**Hyperreflexia, spasticity, positive Babinski sign		**Hyperreflexia, spasticity, positive Babinski sign
	**May present as difficulty walking or frequent falls		**May present as difficulty walking or frequent falls
	*~~'''~~Sensory level~~'''~~ — band-like numbness at level of compression		*Sensory level — band-like numbness at level of compression
	*~~'''~~Bowel/bladder dysfunction~~'''~~ — urinary retention, incontinence (late finding; poor prognostic sign)		*Bowel/bladder dysfunction — urinary retention, incontinence (late finding; poor prognostic sign)
	*~~'''~~Fever + back pain + neurologic deficit~~'''~~ = ~~'''~~epidural abscess until proven otherwise~~'''~~		*Fever + back pain + neurologic deficit = epidural abscess until proven otherwise
	*Vertebral tenderness to palpation		*Vertebral tenderness to palpation

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	**Emergent MRI — do not delay		**Emergent MRI — do not delay
	**CT myelography if MRI unavailable or contraindicated		**CT myelography if MRI unavailable or contraindicated
	*~~'''~~Labs~~'''~~		*Labs
	**If infection suspected: CBC, ESR, CRP, blood cultures (ESR >20 has high sensitivity for epidural abscess)		**If infection suspected: CBC, ESR, CRP, blood cultures (ESR >20 has high sensitivity for epidural abscess)
	**If malignancy: LDH, calcium, alkaline phosphatase		**If malignancy: LDH, calcium, alkaline phosphatase
	**Coagulation studies if epidural hematoma suspected		**Coagulation studies if epidural hematoma suspected
	*X-rays of spine: may show vertebral body destruction, but ~~'''~~cannot rule out cord compression~~'''~~		*X-rays of spine: may show vertebral body destruction, but cannot rule out cord compression

	==Management==		==Management==
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	===Epidural Abscess===		===Epidural Abscess===
	*Broad-spectrum IV antibiotics: ~~'''~~Vancomycin~~'''~~ + ~~'''~~Ceftriaxone~~'''~~ (or Cefepime)		*Broad-spectrum IV antibiotics: Vancomycin + Ceftriaxone (or Cefepime)
	*Blood cultures before antibiotics (if does not delay treatment)		*Blood cultures before antibiotics (if does not delay treatment)
	*Emergent neurosurgical consultation for drainage		*Emergent neurosurgical consultation for drainage
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	==Disposition==		==Disposition==
	*~~'''~~Admit~~'''~~ all cases of spinal cord compression		*Admit all cases of spinal cord compression
	*New neurologic deficits require emergent evaluation and treatment		*New neurologic deficits require emergent evaluation and treatment
	*Ambulatory status at presentation is the strongest predictor of outcome		*Ambulatory status at presentation is the strongest predictor of outcome

Danbot: Major expansion: etiology, dexamethasone dosing, epidural abscess workup, MRI indications, references

2026-03-21T18:35:21Z

Major expansion: etiology, dexamethasone dosing, epidural abscess workup, MRI indications, references

Show changes

Danbot: Expanded with concise EM-focused content: time-sensitive diagnosis, red flags, MRI urgency, steroid dosing, abscess distinction, disposition

2026-03-21T00:44:37Z

Expanded with concise EM-focused content: time-sensitive diagnosis, red flags, MRI urgency, steroid dosing, abscess distinction, disposition

← Revisión anterior		Revisión del 00:44 21 mar 2026
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	==Background==		==Background==
	*Most ~~often~~ from cancer		*Non-traumatic spinal cord compression is an oncologic and neurologic emergency
	**[[Multiple myeloma]], ~~[[lymphoma]]~~, prostate, ~~lung~~, ~~breast~~		*Most commonly from '''metastatic cancer''' (breast, lung, prostate, renal, myeloma, lymphoma)
	*Site ~~of Compression~~: ~~Thoracic~~ > ~~Cervical~~ > ~~Lumbar~~		*Site: thoracic spine (60-70%) > lumbar > cervical
	*The [[cauda equina]] ~~(Latin for "horse's tail")~~ begins at the ~~2nd Lumbar space extending down to the beginning of the sacral nerves. It is distal to the tapered end of the spinal cord, or conus medularis.~~<ref>Cohen MS, Wall EJ, Kerber CW, et al. The Anatomy of the Cauda Equina on CT Scans and MRI. J Bone Joint Surg Br 1991; 73 (3): 381-84.</ref>		*Neurologic deficits may be irreversible if treatment is delayed — '''time is spine'''
			*The [[cauda equina]] begins at the L2 level; compression below this level produces a [[cauda equina syndrome\|lower motor neuron pattern]]<ref>Cohen MS, Wall EJ, Kerber CW, et al. The Anatomy of the Cauda Equina on CT Scans and MRI. J Bone Joint Surg Br 1991; 73 (3): 381-84.</ref>
	{{Epidural compression syndromes types}}		{{Epidural compression syndromes types}}

	==Clinical Features==		==Clinical Features==
			*'''Back pain''' is the earliest and most common symptom (>90%) — often precedes neurologic deficits by weeks
			*Progressive weakness (typically bilateral)
			*Sensory loss below the level of compression (sensory level)
			*Bowel/bladder dysfunction (late finding — urinary retention, incontinence)
			*Gait difficulty
	{{Epidural compression syndromes clinical}}		{{Epidural compression syndromes clinical}}

			===Red Flags===
			*Known cancer + new back pain (cord compression until proven otherwise)
			*Bilateral leg weakness
			*Sensory level on exam
			*Urinary retention or incontinence
			*Saddle anesthesia

	==Differential Diagnosis==		==Differential Diagnosis==
	{{Spinal cord syndromes DDX}}		{{Spinal cord syndromes DDX}}
			{{Lower back pain DDX}}

	~~{{Lower back pain DDX}}~~		===Causes===
			*'''Metastatic epidural disease''' (most common)
			*'''[[Epidural abscess (spinal)\|Epidural abscess]]''' (fever, IVDU, recent procedure)
			*'''[[Epidural hematoma (spinal)\|Epidural hematoma]]''' (anticoagulation, post-procedure)
			*Primary spinal tumor
			*Disc herniation (massive central herniation)
			*Vertebral fracture with retropulsion

	==Evaluation==		==Evaluation==
	*~~[[mri\|~~MRI]] is study of choice		*'''MRI of entire spine''' is the study of choice — order emergently
	**If unavailable ~~consider~~ CT myelography		**Image entire spine (may have multiple levels of compression)
			**If MRI unavailable: CT myelography
			*Bladder scan for post-void residual (>200 mL suggests neurogenic bladder)
			{{Epidural compression syndromes diagnosis}}

	~~{{Epidural compression syndromes diagnosis}}~~		===Labs===
			*[[CBC]], [[BMP]], coagulation studies
			*[[ESR]], [[CRP]] (elevated in abscess, tumor)
			*Blood cultures if abscess suspected
			*PSA, serum protein electrophoresis if cancer workup needed

	==Management==		==Management==
	~~#Consult~~ neurosurgery and/or ~~rad onc~~		*'''Emergent consultation''': neurosurgery and/or radiation oncology
	~~#[[Corticosteroid]] therapy~~		*'''Dexamethasone''': 10 mg IV bolus then 4 mg IV q6h (for malignant compression)
	#*~~Extremely controversial and perhaps no longer indicated in nontraumatic compression~~<ref>Coleman WP, et al: A critical appraisal of the reporting of the National		**Controversial for non-malignant causes — consider risks<ref>Coleman WP, et al. A critical appraisal of the reporting of the National Acute Spinal Cord Injury Studies (II and III) of methylprednisolone in acute spinal cord injury. J Spinal Disord 2000; 13:185.</ref><ref>Hurlbert RJ. Methylprednisolone for acute spinal cord injury: An inappropriate standard of care. J Neurosurgery 2000; 93(1 Suppl):1</ref>
	Acute Spinal Cord Injury Studies (II and III) of methylprednisolone in acute spinal cord injury. J Spinal Disord 2000; 13:185.</ref><ref> Hurlbert RJ: Methylprednisolone for acute spinal cord injury: An		**Do NOT give steroids if [[epidural abscess (spinal)\|epidural abscess]] suspected (will worsen infection)
	inappropriate standard of care. J Neurosurgery 2000; 93(1 Suppl):1</ref>		*Definitive treatment: emergent radiation, surgical decompression, and/or chemotherapy based on tumor type
	#*~~Consider~~ emergent radiation, surgical ~~intervention~~, and/or ~~chemo therapy~~		*'''Epidural abscess''': emergent surgical drainage + IV antibiotics
			*'''Epidural hematoma''': reverse anticoagulation, emergent surgical evacuation
			*Foley catheter for urinary retention
	{{Epidural compression syndromes management}}		{{Epidural compression syndromes management}}

	==Disposition==		==Disposition==
	*Admit		*Admit all patients with confirmed or suspected cord compression
			*ICU if hemodynamically unstable or rapidly progressing deficits
			*Ambulatory status at time of diagnosis is the strongest predictor of outcome — patients who are still ambulatory have the best prognosis

	==See Also==		==See Also==
			*[[Epidural compression syndromes]]
			*[[Cauda equina syndrome]]
	*[[Spinal Cord Trauma]]		*[[Spinal Cord Trauma]]
	*[[~~Spinal Column Injuries~~ (~~Cervical~~)]]		*[[Epidural abscess (spinal)]]
	*[[Neurogenic Shock]]
	*[[Spinal cord syndromes]]		*[[Spinal cord syndromes]]
	*[[Epidural compression syndromes]]

	==References==		==References==
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	[[Category:Neurology]]		[[Category:Neurology]]
	[[Category:Orthopedics]]		[[Category:Orthopedics]]
			[[Category:Oncology]]

ClaireLewis at 15:42, 3 October 2019

2019-10-03T15:42:07Z

← Revisión anterior		Revisión del 15:42 3 oct 2019
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	==Background==		==Background==
	*Most often from cancer		*Most often from cancer
	**Multiple ~~Myeloma~~, ~~Lymphoma~~, ~~Prostate~~, ~~Lung Breast~~		**[[Multiple myeloma]], [[lymphoma]], prostate, lung, breast
	*Site of Compression: Thoracic > Cervical > Lumbar		*Site of Compression: Thoracic > Cervical > Lumbar
	*The cauda equina (Latin for "horse's tail") begins at the 2nd Lumbar space extending down to the beginning of the sacral nerves. It is distal to the tapered end of the spinal cord, or conus medularis.<ref>Cohen MS, Wall EJ, Kerber CW, et al. The Anatomy of the Cauda Equina on CT Scans and MRI. J Bone Joint Surg Br 1991; 73 (3): 381-84.</ref>		*The [[cauda equina]] (Latin for "horse's tail") begins at the 2nd Lumbar space extending down to the beginning of the sacral nerves. It is distal to the tapered end of the spinal cord, or conus medularis.<ref>Cohen MS, Wall EJ, Kerber CW, et al. The Anatomy of the Cauda Equina on CT Scans and MRI. J Bone Joint Surg Br 1991; 73 (3): 381-84.</ref>

	{{Epidural compression syndromes types}}		{{Epidural compression syndromes types}}
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	==Evaluation==		==Evaluation==
	*MRI is study of choice		*[[mri\|MRI]] is study of choice
	**If unavailable consider CT myelography		**If unavailable consider CT myelography

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	==Management==		==Management==
	#Consult neurosurgery and/or rad onc		#Consult neurosurgery and/or rad onc
	#Corticosteroid therapy		#[[Corticosteroid]] therapy
	#*Extremely controversial and perhaps no longer indicated in nontraumatic compression<ref>Coleman WP, et al: A critical appraisal of the reporting of the National		#*Extremely controversial and perhaps no longer indicated in nontraumatic compression<ref>Coleman WP, et al: A critical appraisal of the reporting of the National
	Acute Spinal Cord Injury Studies (II and III) of methylprednisolone in acute spinal cord injury. J Spinal Disord 2000; 13:185.</ref><ref> Hurlbert RJ: Methylprednisolone for acute spinal cord injury: An		Acute Spinal Cord Injury Studies (II and III) of methylprednisolone in acute spinal cord injury. J Spinal Disord 2000; 13:185.</ref><ref> Hurlbert RJ: Methylprednisolone for acute spinal cord injury: An

Rossdonaldson1: Text replacement - "surg " to "surgery "

2016-08-01T17:39:41Z

Text replacement - "surg " to "surgery "

← Revisión anterior		Revisión del 17:39 1 ago 2016
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	#*Extremely controversial and perhaps no longer indicated in nontraumatic compression<ref>Coleman WP, et al: A critical appraisal of the reporting of the National		#*Extremely controversial and perhaps no longer indicated in nontraumatic compression<ref>Coleman WP, et al: A critical appraisal of the reporting of the National
	Acute Spinal Cord Injury Studies (II and III) of methylprednisolone in acute spinal cord injury. J Spinal Disord 2000; 13:185.</ref><ref> Hurlbert RJ: Methylprednisolone for acute spinal cord injury: An		Acute Spinal Cord Injury Studies (II and III) of methylprednisolone in acute spinal cord injury. J Spinal Disord 2000; 13:185.</ref><ref> Hurlbert RJ: Methylprednisolone for acute spinal cord injury: An
	inappropriate standard of care. J ~~Neurosurg~~ 2000; 93(1 Suppl):1</ref>		inappropriate standard of care. J Neurosurgery 2000; 93(1 Suppl):1</ref>
	#*Consider emergent radiation, surgical intervention, and/or chemo therapy		#*Consider emergent radiation, surgical intervention, and/or chemo therapy

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-26T02:19:38Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Revisión anterior		Revisión del 02:19 26 jul 2016
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	{{Lower back pain DDX}}		{{Lower back pain DDX}}

	==~~Diagnosis~~==		==Evaluation==
	*MRI is study of choice		*MRI is study of choice
	**If unavailable consider CT myelography		**If unavailable consider CT myelography

Neil.m.young: Text replacement - "==Treatment==" to "==Management=="

2016-07-09T05:45:07Z

Text replacement - "==Treatment==" to "==Management=="

← Revisión anterior		Revisión del 05:45 9 jul 2016
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	{{Epidural compression syndromes diagnosis}}		{{Epidural compression syndromes diagnosis}}

	==~~Treatment~~==		==Management==
	#Consult neurosurgery and/or rad onc		#Consult neurosurgery and/or rad onc
	#Corticosteroid therapy		#Corticosteroid therapy

Neil.m.young: Text replacement - "* " to "*"

2016-07-07T00:36:17Z

Text replacement - "* " to "*"

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	==Background==		==Background==
	*Most often from cancer		*Most often from cancer
	** Multiple Myeloma, Lymphoma, Prostate, Lung Breast		**Multiple Myeloma, Lymphoma, Prostate, Lung Breast
	* Site of Compression: Thoracic > Cervical > Lumbar		*Site of Compression: Thoracic > Cervical > Lumbar
	*The cauda equina (Latin for "horse's tail") begins at the 2nd Lumbar space extending down to the beginning of the sacral nerves. It is distal to the tapered end of the spinal cord, or conus medularis.<ref>Cohen MS, Wall EJ, Kerber CW, et al. The Anatomy of the Cauda Equina on CT Scans and MRI. J Bone Joint Surg Br 1991; 73 (3): 381-84.</ref>		*The cauda equina (Latin for "horse's tail") begins at the 2nd Lumbar space extending down to the beginning of the sacral nerves. It is distal to the tapered end of the spinal cord, or conus medularis.<ref>Cohen MS, Wall EJ, Kerber CW, et al. The Anatomy of the Cauda Equina on CT Scans and MRI. J Bone Joint Surg Br 1991; 73 (3): 381-84.</ref>

Ostermayer: Text replacement - "Category:Ortho" to "Category:Orthopedics"

2016-03-22T15:47:08Z

Text replacement - "Category:Ortho" to "Category:Orthopedics"

← Revisión anterior		Revisión del 15:47 22 mar 2016
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	[[Category:Neurology]]		[[Category:Neurology]]
	[[Category:~~Ortho~~]]		[[Category:Orthopedics]]

Ostermayer: Text replacement - "Category:Neuro" to "Category:Neurology"

2016-03-22T14:15:11Z

Text replacement - "Category:Neuro" to "Category:Neurology"

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	<references/>		<references/>

	[[Category:~~Neuro~~]]		[[Category:Neurology]]
	[[Category:Ortho]]		[[Category:Ortho]]