Signs and Symptoms of Spinal Cord Compression
Back pain is the cardinal symptom, present in approximately 90% of patients with spinal cord compression, often appearing as the earliest warning sign before neurological deficits develop. 1, 2, 3
Pain Characteristics
- Local pain occurs at the site of spinal compression and is the most common presenting symptom 2, 3
- Radicular pain radiates along nerve root distributions in dermatomal patterns, extending from the spine outward 1, 2, 3
- Pain alone is not predictive of malignant spinal cord compression, but new or worsening back pain in cancer patients warrants immediate investigation 2, 4
Motor Dysfunction
- Weakness and gait deterioration occur in approximately 67% of patients before diagnosis 2
- Up to 50% of patients are unable to walk at presentation due to lower extremity weakness 1, 2, 3
- Motor deficits (71%) are more common than sensory deficits on physical examination 5
- Gait ataxia may be present even without associated motor or sensory deficits, making it a critical examination finding 5
- Decreased hand dexterity is a hallmark symptom, particularly in cervical spondylotic myelopathy 6
Sensory Abnormalities
- Sensory changes include numbness, paresthesias, dysesthesias, and sensory level deficits 2, 3
- Loss of sensation to pinprick, temperature, and light touch below the level of compression 3
- Sensory deficits occur in approximately 43% of patients on examination 5
- Importantly, 24% of patients have no motor or sensory deficit at presentation, and 23% have only unilateral findings, making diagnosis challenging 5
Autonomic Dysfunction
- Bladder and bowel dysfunction occurs in up to 50% of patients at presentation 1, 2, 3
- Urinary symptoms include urgency, incontinence, incomplete emptying, dribbling stream, or urinary retention 3
- Bowel dysfunction presents as fecal urgency, incontinence, or constipation 3
- Sphincter dysfunction is part of the clinical definition of spinal cord compression 1
- Perianal or saddle numbness is characteristic of cauda equina syndrome 1
Critical Clinical Pitfalls
- Spinal cord compression can have a subtle presentation with absent or unilateral motor and sensory deficits 5
- ED misdiagnosis occurs in 29% of cases, resulting in significant treatment delays (median 54 hours vs. 5.3 hours) 5
- The natural history if untreated is relentless progression to paralysis, complete sensory loss, and sphincter dysfunction 1, 3
- Pretreatment ambulatory status is the single strongest predictor of post-treatment function—ambulatory patients have 96-100% chance of remaining ambulatory after treatment, while paraplegic patients have only 2-6% chance of regaining walking ability 2, 7
Timing and Urgency
- Patients with paralysis at presentation have significantly shorter life expectancy than ambulatory patients 2, 3
- 70% of patients experience loss of neurologic function between symptom onset and treatment initiation, with two-thirds of delays attributed to patients not recognizing symptoms as urgent 7
- Treatment delay directly impacts functional outcomes, particularly preservation of ambulation 3
- Patients with slower motor deficit development (>14 days) have significantly better functional outcomes than those with rapid progression (<14 days) 2, 7