Spinal Cord Compression

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Remember that quick action may prevent irreversible damage - tetraplegia, tetraparesis, paraplegia, paraparesis.
The urgency is dictated by the duration, the rate of progression, and the degree of neurological deficit. Try to establish the level of cord involvement in order to target investigations.
If recent onset, rapid progression, and/or significant neurological deficit, obtain immediate (i.e., at once) neurological/neurosurgical consultation and MRI of the whole spine.
Catheterize if urinary retention present and record residual volume.
CBC + diff, ESR, Na, glucose, K, Ca, creatinine, AST, ALT, GGT, ALP, bili, albumin, CXR. Serum protein electrophoresis and serum free light chains. Prostate specific antigen may be indicated. Search for underlying malignancy. Commonest primaries are lung, breast, melanoma, prostate, lymphoma and myeloma.
Remember that in some tumours (e.g., myeloma, secondary deposits), radiotherapy and/or chemotherapy may be the treatment of choice. Urgent consultation with a Haematologist or Oncologist is recommended.
Regular turning to avoid pressure sores.
If patients with a known malignancy develop spinal cord compression it is essential that the doctors who have been supervising their care be contacted immediately.
Corticosteroids, e.g., methylprednisolone or dexamethasone should be considered once the diagnosis is confirmed. In particular, diagnosis of abscess or lymphoma must be considered before steroids are given.


Information about this CDHB document (1536):
Document Owner:	Blue Book Editorial Committee (see Who's Who)
Issue Date:	December 2013
Next Review:	December 2015
Keywords:
Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document.
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Topic Code: 1536