What is the treatment for T12 spinal cord compression?

Treatment for T12 Spinal Cord Compression

Immediate surgical decompression is the primary treatment for T12 spinal cord compression, especially in patients with neurological deficits, and should be performed as soon as possible to improve neurological outcomes. 1, 2

Initial Management

• Corticosteroids: Start high-dose dexamethasone immediately upon suspicion of spinal cord compression to reduce edema and inflammation 1, 2
• Imaging: Obtain emergent MRI to confirm compression, determine acuity, and plan surgical approach 3
  • If MRI is contraindicated, consider Tc-99m bone scan or SPECT/CT 3

Definitive Treatment

Surgical Management

Indications for surgery include:

• Neural element compression with neurological deficit
• Spinal fracture causing instability
• Displaced fracture fragment causing neural compromise
• Failed conservative management 3

Surgical options:

1. Decompression with stabilization: Removes pressure on the spinal cord and stabilizes the spine 1, 3
2. Timing: Early decompression (within 24 hours, ideally within 12 hours) is associated with better neurological outcomes 1, 4
   • Studies show 55% of patients can be decompressed within 12 hours of injury without increased complications 1
   • Early surgery has been shown to improve neurological function compared to delayed intervention 4

Radiation Therapy

• For patients with metastatic spinal cord compression who are not surgical candidates 2
• Can be used as adjuvant therapy after surgical decompression in metastatic disease 2

Conservative Management

May be appropriate for:

• Stable isolated pedicle fractures
• Spinous process fractures
• Transverse process fractures 3

Conservative approaches include:

• Physical therapy and rehabilitation
• Pain management
• Cervical collar or bracing as appropriate 3

Special Considerations

Metastatic Disease

• Combined approach of corticosteroids, surgery, and radiation yields best outcomes 2
• Vertebroplasty or kyphoplasty may be considered for pathological fractures 1
• Only consider vertebral augmentation if patient has failed conservative therapy for 3 months with persistent pain and functional limitations 3

Complications to Monitor

• Dysphagia (62.5% in circumferential cervical decompression)
• Recurrent laryngeal nerve palsy (2.8%)
• Wound infections (5.6%)
• Pneumonia (6.9%) 5

Prognostic Factors

• Timing: Earlier intervention is associated with better outcomes 1, 4
• Extent of cord compression: Greater cord compression and swelling correlate with poorer neurological recovery 6
• Duration of symptoms: Patients with symptom duration >1 year have decreased likelihood of favorable outcomes 3
• Complete vs. incomplete injury: Incomplete injuries have better recovery potential 1

Follow-up Care

• Structured physical therapy program targeting spinal stabilization 3
• Long-term balance training and muscle strengthening 3
• Consider calcium (1000-1200 mg/day) and vitamin D (800 IU/day) supplementation to prevent further fractures 3

The evidence strongly supports early surgical intervention for T12 spinal cord compression with neurological deficits, with studies showing improved outcomes with decompression performed within 24 hours of injury 1, 4.