Spinal cord compression is an oncological emergency and affects up to 5% of cancer patients. Extradural compression accounts for the majority of cases, usually due to vertebral body metastases. It is more common in patients with lung, breast and prostate cancer

PC

• back pain
  • the earliest and most common symptom
  • may be worse on lying down and coughing
• lower limb weakness
• sensory changes: sensory loss and numbness
• neurological signs depend on the level of the lesion. Lesions above L1 usually result in upper motor neuron signs in the legs and a sensory level. Lesions below L1 usually cause lower motor neuron signs in the legs and perianal numbness. Tendon reflexes tend to be increased below the level of the lesion and absent at the level of the lesion

Investigation

• urgent MRI: the 2019 NICE guidelines recommend a whole MRI spine within 24 hours of presentation

Management

• high-dose oral dexamethasone
• urgent oncological assessment for consideration of radiotherapy or surgery