What are the symptoms of cord compression syndrome?

Symptoms of Cord Compression Syndrome

The primary symptoms of cord compression syndrome include pain (local and/or radicular) in 90% of patients, weakness, sensory disturbance, and sphincter dysfunction, with up to 50% of patients being unable to walk at presentation. 1

Clinical Presentation

Pain Characteristics

• Back pain (local or radicular) occurs in 88-90% of patients 1
• Pain may be:
  • Dull and aching
  • Sharp, lancinating, or electrical
  • Dysesthetic in character
• Pain may be aggravated by flexion and extension of the spine or by walking/running
• In older teenagers and adults, pain may radiate into the groin, genitals, and/or perianal region 1

Motor Symptoms

• Progressive weakness, typically worse in upper extremities than lower extremities in central cord syndrome 2
• Difficulty walking or running
• Muscle atrophy (thinning of calf muscles)
• Decreased athletic performance
• Progressive difficulty with ambulation 1

Sensory Abnormalities

• Sensory deficits typically start distally in the leg and become more proximal over time
• "Suspended" sensory loss may occur with preserved sensation both above and below the affected area 1
• Prominent sensory complaints in the hands (especially in central cord syndrome) 2
• Paresthesias and dysesthesias

Autonomic Dysfunction

• Bladder dysfunction (44% of patients) 3
  • Urinary urgency and/or incontinence
  • Urinary tract infections
  • Dribbling urinary stream
  • Incomplete emptying
  • Inability to void
• Bowel dysfunction
  • Fecal urgency and/or incontinence
  • Constipation (34% of patients) 3

Other Signs and Symptoms

• Orthopedic deformities:
  • Progressive scoliosis
  • Exaggerated lumbosacral lordosis
  • Foot deformities
• In long-standing cases:
  • Thin, shiny, hairless skin on legs and feet due to autonomic changes
  • Areas of skin breakdown and chronic discoloration 1

Progression and Warning Signs

• Symptoms typically progress if untreated, leading to relentless and progressive neurological deterioration 1
• Sudden appearance of new pain and/or neurologic deficits after back stretching (e.g., during childbirth, falls onto buttocks, vigorous sports) may indicate acute cord compression 1
• Patients with paralysis either at presentation or after treatment have a much shorter life expectancy than ambulatory patients 1

Diagnostic Considerations

• MRI with contrast enhancement is the gold standard for diagnosis with sensitivity ranging from 0.44 to 0.93 and specificity from 0.90 to 0.98 4
• CT myelography may be used as an alternative when MRI is contraindicated 4
• Back pain alone is not predictive of spinal cord compression, but progressive neurological symptoms warrant urgent imaging 4

Clinical Pitfalls

• Delayed diagnosis can lead to irreversible neurological deficits 4
• Symptoms may be misdiagnosed as other conditions (e.g., Charcot-Marie-Tooth syndrome) 1
• In children and teenagers, subtle abnormalities may be present from early childhood before more severe symptoms develop 1
• Patients with a history of cancer who develop new back pain should be evaluated urgently for possible cord compression 1

Early recognition and prompt treatment of cord compression syndrome are essential to prevent permanent neurological damage and improve outcomes, with pretreatment ambulatory status being the most important prognostic factor 4.