SHM's Clinical Quick Talks-Acute Inpatient Management of Spinal Cord Compression

Pdf Summary

Acute spinal cord compression (SCC) is a critical medical emergency requiring rapid diagnosis and treatment to prevent permanent neurological damage. It can be caused by trauma (fractures, dislocations), malignancy (primary or metastatic tumors), infections (epidural abscess, osteomyelitis), or hematoma (often linked to anticoagulation). Less common causes include degenerative disorders like severe spondylosis, herniated discs, and inflammatory diseases such as rheumatoid arthritis or ankylosing spondylitis.<br /><br />Clinically, patients typically present with severe localized back or neck pain, motor weakness or paralysis, sensory disturbances, and bowel or bladder dysfunction. Red flags include rapid neurological deterioration, unrelenting pain, and signs of spinal shock (hypotension, bradycardia). A thorough history should assess symptom onset and progression, trauma, cancer history, infection signs, anticoagulant use, prior spinal interventions, and intravenous drug use.<br /><br />Diagnosis relies heavily on urgent imaging, with non-contrast MRI of the entire spine being the gold standard; CT myelography is used if MRI is contraindicated. Laboratory tests include CBC, inflammatory markers (CRP/ESR), and blood cultures if infection is suspected.<br /><br />Treatment involves high-dose corticosteroids (dexamethasone), urgent surgical decompression for neurologic decline or instability, radiation therapy primarily for malignant causes, and antibiotics for infectious etiologies. Supportive measures include pain management, thromboprophylaxis, bowel and bladder care, and early physical rehabilitation.<br /><br />A multidisciplinary team comprising neurosurgery, oncology, infectious diseases, and rehabilitation medicine specialists is essential for optimal management and prognosis. Clinicians must maintain a high index of suspicion for SCC in patients with new or worsening back pain and neurological deficits and act promptly to improve outcomes.

Asset Subtitle

Zain Abidin, Nicole Terrigno

Keywords

acute spinal cord compression

neurological emergency

spinal trauma

malignancy

epidural abscess

osteomyelitis

spinal hematoma

MRI spine

surgical decompression

corticosteroids