From the Guidelines
Excluding spinal cord compression requires a thorough evaluation of clinical and radiographic features. The diagnostic criteria for excluding spinal cord compression involve assessing for the absence of clinical features such as pain (local or radicular), weakness, sensory disturbance, and/or evidence of sphincter dysfunction, as well as radiographic features including compression of the dural sac and its contents by a tumor mass 1.
Clinical Features
- Pain: Local or radicular pain is a common symptom of spinal cord compression, and its absence can help exclude the diagnosis.
- Weakness: The absence of weakness or sensory disturbance can also help rule out spinal cord compression.
- Sphincter dysfunction: The absence of sphincter dysfunction, such as bladder or bowel dysfunction, can also be used to exclude spinal cord compression.
Radiographic Features
- MRI: Sagittal T1-weighted MRI with or without gadolinium of the entire spine is recommended to evaluate for spinal cord compression 1.
- Compression of the dural sac: The absence of compression of the dural sac and its contents by a tumor mass can help exclude spinal cord compression.
- Indentation of the theca: The absence of indentation of the theca at the level of clinical features can also help rule out spinal cord compression.
Additional Evaluation
- MRI spine: MRI is useful for evaluating the spinal cord and surrounding structures, and can help exclude alternative etiologies such as demyelinating diseases or infections 1.
- Intravenous contrast: IV contrast may be used to evaluate for complications in the early postoperative setting, or to assess for inflammatory or infectious etiologies 1.
- Diffusion-weighted imaging: Diffusion-weighted imaging can show signal alteration in the spinal cord earlier after symptom onset, and can be useful in cases where spinal cord ischemia is suspected 1.
From the Research
Diagnostic Criteria for Excluding Spinal Cord Compression
To exclude spinal cord compression, the following criteria can be considered:
- The absence of symptoms such as back pain, motor weakness, and sensory change 2
- The absence of motor and sensory deficits on physical examination, although it is noted that some patients with spinal cord compression may not exhibit these deficits 3
- The absence of impaired gait, although this may not be a reliable indicator in all cases 3
- A spinal cord occupation ratio (SCOR) of less than 70% on midsagittal imaging or less than 80% on axial imaging, which may indicate a lower risk of cord-canal mismatch and spinal cord compression 4
Clinical Presentation
The clinical presentation of spinal cord compression can vary, but common symptoms include:
- Back pain 2, 3, 5
- Motor weakness 2, 3, 5
- Sensory change 2
- Difficulty ambulating 3
- Bowel and bladder dysfunction 6
- Neck or back pain 6
Diagnostic Challenges
It is noted that spinal cord compression can have a subtle presentation, with absent or unilateral motor and sensory deficits, and that misdiagnosis can occur in non-trauma patients 3. Therefore, a high index of suspicion and careful evaluation are necessary to exclude spinal cord compression.