Spinal cord compression

Spinal cord compression happens when pressure on the spinal cord stops the nerves working normally. This can cause back pain and other symptoms such as arm or leg weakness or difficulty walking.

It is also called metastatic spinal cord compression (MSCC). Metastatic means that the cancer has spread to the spine from another part of the body. 

What are the symptoms of spinal cord compression?

Symptoms depend on where the pressure in the spinal cord is. Pain is often the first symptom and more than 90 out of 100 people (90%) with spinal cord compression have it. The pain:

• could be anywhere in your back, spine or neck

• may feel like a tight band around your body

• in your spine could be made worse when you cough, sneeze or go to the toilet

• is getting worse or doesn’t go away

• is stopping you sleeping or wakes you up at night

• is made worse by lying flat on your back, or by standing or moving around

Other symptoms might include:

• weakness in your legs or arms

• difficulty walking

• changes to sensations in your body, such as pins and needles or numbness

• not being able to go for a wee or poo

• difficulty controlling your bladder or bowel

• erection problems

What to do if you have symptoms

Contact your hospital team straight away if you have any symptoms of spinal cord compression. You should have an emergency number to call.

They might ask you to go to your nearest hospital straight away. This might not be your usual hospital. It’s important to follow their instructions so you are seen quickly.

If you can't get through to your hospital team, contact your GP or go to your nearest accident and emergency department (A&E). 

The spinal cord

The spinal cord is a long bundle of nerves that stretches from the brain to the lower part of the back. The nerves send messages from the brain to control movement and feeling in different parts of our body.

Bones called vertebrae protect the spinal cord. The vertebrae make up the spinal column. Cerebral spinal fluid (CSF), fat and tissue also help protect the spinal cord inside the spinal column.

The nerves from the spinal cord extend into regions. The diagram below shows what regions of the body the nerves control. 

What is spinal cord compression?

Spinal cord compression happens when there is pressure on the spinal cord. Pressure on the spinal cord causes the nerves in the spinal cord to swell and slows down or blocks their blood supply. This stops the nerves working normally.

Cancer in the spinal bones can cause pressure. There are different names depending on where the cancer started. You might hear it called:

• malignant spinal cord compression when the cancer started in the spine

• metastatic spinal cord compression when the cancer cells have spread into the spinal bones from another part of the body

Spinal cord compression can also happen in people who do not have cancer.

Who is at risk?

Around 3 to 5 in 100 people (around 3 to 5%) with advanced cancer develop spinal cord compression. Almost any type of cancer can spread to the spine.

You’re at higher risk of developing spinal cord compression if you have cancer that:

• has already spread to your bones

• is at high risk of spreading to your bones, such as prostate, breast, lung or myeloma

• started in your spine

Tests for spinal cord compression

You’ll have an urgent MRI scan of your back if your doctors think you might have spinal cord compression. You might also have a CT scan. 

You usually have this scan within 24 hours of your doctor suspecting you have spinal cord compression. 

Your doctor might want to take a sample of the cancer (biopsy) if they aren't sure what type it is. They will only do this if knowing your cancer type affects what treatment you have. And if it doesn't delay any urgent treatment you need.

Treatment

Starting treatment early helps stop the symptoms getting worse or becoming permanent.

Your feelings

It can be difficult to cope with the changes caused by spinal cord compression. Having pain has a big impact on how your feel in yourself and interferes with your daily life. To begin with you will need to rest flat in bed which can be very difficult to adjust to. It can be frustrating being unable to move around or do things for yourself.

It’s normal to feel a range of emotions, including being upset and frightened. There is no ‘right’ way to feel and everyone is different.

Tell your healthcare team how you feel. They can find the best person to help.

There are some things that might help:

• Getting information about spinal cord compression and your cancer can help you cope, so you know what to expect.
• Talking to your health care team about changes they can make to help you be more independent and perform daily activities (such as moving around or washing) - both in hospital and if you plan to go home.
• Some hospitals have a complementary therapy service you could access for free.