Malignant spinal cord compression occurs when a cancerous tumor presses on the spinal cord, a bundle of nerves extending from the brain down the back. This pressure can disrupt the normal function of the spinal cord, which transmits signals between the brain and the rest of the body. Recognizing this condition and seeking immediate medical attention is important due to its potential for permanent neurological damage.
Understanding Malignant Spinal Cord Compression
Malignant spinal cord compression develops when cancer spreads to the spine, forming tumors that press on the spinal cord or its branching nerves. Common primary cancers that metastasize to the spine include lung, breast, prostate, kidney cancer, and multiple myeloma.
The spinal column protects the spinal cord, but a tumor growing within or near these bones can reduce space for the spinal cord. This pressure can injure nerve cells, disrupt blood flow, or cause inflammation, impairing nerve function. Understanding the compression’s origin helps guide treatment, as therapies often target both the local compression and the underlying cancer.
Recognizing the Signs
A new or worsening back pain is a common initial symptom of malignant spinal cord compression. This pain often persists even with rest and may intensify at night, differing from typical mechanical back pain. The discomfort can be localized to the spine or radiate to the arms, legs, or chest, depending on the affected spinal level.
As the compression progresses, individuals may experience weakness or numbness in their arms or legs. Difficulty walking, stumbling, or a loss of balance often accompany this neurological decline. Changes in bowel or bladder function, such as difficulty urinating, urinary incontinence, or constipation, also indicate severe spinal cord involvement. Recognizing these evolving symptoms quickly allows for timely intervention, potentially preventing further neurological decline.
Diagnosis and Urgency
Diagnosing malignant spinal cord compression begins with a thorough neurological examination, assessing reflexes, muscle strength, sensation, and coordination. This evaluation helps pinpoint the likely level of spinal cord involvement and neurological deficit. The examination guides imaging studies to confirm diagnosis and identify the compression’s location and nature.
Magnetic Resonance Imaging (MRI) of the spine is the preferred imaging test for diagnosing this condition, as it provides detailed images of the spinal cord, nerves, and surrounding soft tissues. An MRI shows the tumor, compression degree, and any associated swelling or damage. This condition is considered a medical emergency because prolonged compression can lead to irreversible neurological damage, including permanent paralysis. Immediate diagnosis and intervention are paramount to preserve neurological function and improve patient outcomes, as time is a factor in preventing lasting disability.
Treatment Approaches
Immediate treatment for malignant spinal cord compression involves administering high-dose corticosteroids, such as dexamethasone, to reduce swelling around the spinal cord and alleviate pressure. They decrease inflammation and edema, providing rapid symptom relief and preserving neurological function while definitive treatments are planned. Corticosteroids are given intravenously and can quickly improve pain and neurological symptoms.
Radiation therapy is a common and effective treatment, involving focused beams delivered to the affected area of the spine. This therapy aims to shrink the tumor, reducing pressure and alleviating symptoms. It is effective in controlling local tumor growth and can be delivered over several days or weeks, depending on the patient’s condition and cancer type.
Surgical decompression may be considered for cases with significant spinal instability, rapid neurological decline, or when radiation therapy is unsuitable. Procedures like laminectomy or vertebrectomy involve removing bone or tumor to relieve direct pressure. The choice between surgery and radiation depends on factors like overall health, cancer type, and spinal damage extent. Chemotherapy or targeted therapy may also be used with these treatments, depending on the underlying cancer’s sensitivity.
References
National Cancer Institute. “Malignant Spinal Cord Compression (PDQ®)–Health Professional Version.” Accessed July 25, 2025.
American Society of Clinical Oncology (ASCO). “Malignant Spinal Cord Compression.” Accessed July 25, 2025.