Cord Compression

Question 1

What cancers caused malignant compression of the cord?

Answer 1

Lung
Breast
Kidney
Prostate
Thyroid

Question 2

What causes must you rule out in cord compression?

Answer 2

Trauma
Disc prolapse
Haematoma
Epidural abscess
Cervical spondylitic myelopathy

Question 3

Where does malignant cord compression occur most commonly?

Answer 3

60% Thoracic
30% lumbar
10% cervical

Question 4

What clinical features are there in cord compression?

Answer 4

Pain
Motor weakness
Sensory issues
Bladder and bowel involvement

Question 5

What is the pain like in cord compression?

Answer 5

Before any neurological symptoms

Severe and progressive

Question 6

What is motor weakness like in cord compression?

Answer 6

Symmetrical
Pyramidal (affects extensors in the upper body and flexors in the lower body)
Progressive
Altered gait

Question 7

What sensory changes occur in cord compression?

Answer 7

Less common than motor

Paraesthesia peripherally

Question 8

What red flags MUST you ask for in suspected cord compression?

Answer 8

Reduced sensation when wiping
Bilateral sciatica
Incontinence

Question 9

What investigations are done for cord compression?

Answer 9

MRI of full-spine

To visualise the extent of disease

Question 10

How is cord compression managed?

Answer 10

Surgical emergency

Must be admitted

• Dexamethasone to relieve compression
• Analgesia
• Catheterisation

Surgical management to decompress spine

Question 11

If a patient is unable to undergo surgery what can be done for malignant cord compression?

Answer 11

External beam radiotherapy

Can be used as mono-therapy or adjunct to surgery