What is Spinal Cord Compression & How Common is it? | Symptoms, Causes, Risk Factors of Spinal Cord Compression

What is Spinal Cord Compression?

Spinal cord compression happens when there is anything that is putting pressure on the spinal cord. Also known as cervical spondylotic myelopathy (CSM) and the symptoms can develop either suddenly or gradually.(1,2,3,4) The spinal cord is an integral part of the central nervous system, and it is made up of a bundle of nerves that run down the middle of your back. The spine is responsible for sending messages back and forth from your brain to the muscles, soft tissues, and all the other parts of the body. As the spinal cord travels down your back, it is protected by the vertebral column. The vertebral column is a stack of bones that keeps the body upright. The nerves of the spinal cord also run through the many openings between the vertebrae and to the muscles.(5,6)

Spinal cord compression can happen at any place in the spine, including the torso (thoracic spine) and the neck (cervical spine). This is a treatable condition, and treatment may include medication, supportive therapies, and surgery.(7)

What are the Symptoms of Spinal Cord Compression?

The symptoms of spinal cord compression vary from person to person and depend on how severe the compression is and also on which part of the spinal cord is being compressed.

One of the most common symptoms of spinal cord compression is stiffness or pain in the neck or the back. You may also experience weakness or numbness in the hands, legs, and arms. Some people also develop a condition known as cauda equina syndrome, which develops if the compression has happened in the lumbar area. The symptoms of cauda equina syndrome may include:(8,9,10)

  • Loss of bladder and bowel control
  • Severe weakness and pain in the legs
  • Severe numbness or weakness in the inner thighs and back of the legs

Depending on the cause of your spinal cord compression, the symptoms may either develop quickly or slowly. Some injuries can cause you to experience immediate symptoms. Certain health conditions, like an infection or a tumor, may also cause symptoms that come on gradually over a period of several days or even weeks. Wear and tear of the spinal cord can take years to develop, due to which the symptoms vary from person to person.

Some of the more common symptoms of spinal cord compression may include:

  • Loss of feeling in the feet
  • Numbness, weakness, and/or cramping in the arms or legs and hands
  • Burning pain that spreads into the arms, down the legs, or the buttocks, known as sciatica
  • Balance issues
  • Stiffness and pain in the neck, lower back, or upper back
  • Hand coordination problems
  • Weakness of both feet or one foot that causes limping

Spinal cord compression may also impact fine motor skills and coordination. Motor skills and coordination also include the coordination of your fine muscles and daily activities, including buttoning a shirt or handwriting. Spinal cord compression can also impact how a person walks, their reflexes, muscle movement, and their overall range of motion.

What are the Causes of Spinal Cord Compression?

There are many causes of spinal cord compression. The onset of spinal cord compression can happen suddenly sometimes, or it can develop over time in other cases. The causes of spinal cord compression may include:

Disk herniation: A disk herniates when its center, known as the nucleus pulposus, starts to push against the outer ring known as the annulus fibrosus. If the disk gets severely injured or worn out, the nucleus may come out all the way. When a herniated disk starts to bulge out towards the spinal cord, it puts a lot of pressure on the spinal cord, leading to compression. Disk herniation can also happen with sudden pulling, lifting, twisting, and bending movements.(11)

Certain degenerative diseases like arthritis can also lead to spinal cord compression. Compression of the spinal cord due to such conditions can happen when the disks of the vertebrae in the back or neck wear out.(12)

Rheumatoid arthritis: Rheumatoid arthritis is an autoimmune condition where the immune system starts attacking its own healthy tissues. In this disorder, the immune cells start to attack the synovium, which is the thin membrane that lines the joints. This process is known as inflammation, and as the inflammation of the synovium grows, you will start feeling stiffness and pain. Long-term inflammation in the cervical spine can cause damage or destroy the facet joints. The facet joints are the joints in the spine that lend flexibility to your back and allow you to bend over and twist and stand up straight. When this happens, the upper vertebrae may slide on top of the lower vertebra, leading to compression.(13,14)

Injury to the spinal cord or the area around the spinal cord that causes swelling, which in turn can cause compression. This can include any type of injury to the spine, including a sports injury, injury from a car accident, or even a fall.

Bone Spurs: Bone spurs that narrow the spinal canal can also cause compression of the cord. As a person ages, the disks in the spinal cord start to lose their height and may begin to bulge. At the same time, they also low water content, causing them to dry out and become stiff. The result of this is the collapse of the disk space and loss of space height within the spinal cord. When this happens, the vertebrae may start to move closer together, and the body will respond to the collapsed disk by forming bone spurs in order to strengthen the disk. Bone spurs not only cause narrowing of the spinal canal but also cause stiffness, which may begin to compress the spinal cord.(15)

Bleeding disorders combined with chiropractic manipulation can lead to the formation of large clots that compress the spinal cord.

Cancerous and non-cancerous tumors that come up in the space near the spinal cord. The tumor can apply pressure on the cord, thus causing compression. In the case of tumors, treatment may include surgery and medications. If the tumor is cancerous, you may need chemotherapy and/or radiation therapy also.(16)

What are the Risk Factors for Spinal Cord Compression?

It is possible for anyone to injure their spinal cord or develop a health condition that causes compression of the spinal cord. Even though the injury is the main risk of developing spinal cord compression, there are some factors that increase the risk of developing spinal cord compression.

This may include poor lifting practices, strenuous exercising without following proper precautions, and many others. People who have inflammatory arthritis or osteoarthritis also have a greater risk of developing spinal cord compression.(17)

How Common is Spinal Cord Compression?

Studies show that the global prevalence of spinal cord compression is around 1,298 per one million people annually. In contrast, in the United States, approximately 11,000 traumatic spinal cord injuries are recorded every year. More than half of all the incidences of spinal cord compression are observed in people between the ages of 16 to 30 years.(18)

Data from the American Association of Neurological Surgeons also show that spinal cord compression incidences have been on a steady rise over the last ten years. Men account for over 80 percent of all spinal cord injuries, with nearly 90 percent of these being sports-related injuries. Both genders are equally affected in cases of automobile accidents, gunshots, and falls. Incidences in women were mostly found to be related to surgical or other medical complications.(19)

Diagnosing Spinal Cord Compression

To make a diagnosis of spinal cord compression, your doctor will first ask questions about your medical history, symptoms and also carry out a thorough physical examination. During the physical examination, your doctor will look for any signs that could indicate spinal compression, including loss of feeling in the arms and legs, weakness, and any type of abnormal reflexes.

Your doctor will also prescribe diagnostic tests to determine the exact cause of your symptoms and to reach a diagnosis of spinal cord compression. These tests may include:

Spinal X-rays: X-rays are used to look for bone spurs that may be pushing against the spinal nerves. X-rays may also indicate any abnormal alignment of the spine.

Special imagine: A CT scan or an MRI scan may be prescribed to get a more detailed view of your spinal cord and the tissues surrounding the cord.

Additional tests: Your doctor may also do a myelogram, which is a special type of CT scan that injects a dye into your spinal column. Or they may order an electromyography, which is an electrical test that measures muscle activity in the body.(20,21)

How is a Spinal Cord Compression Treated?

There are several options for treating spinal cord compression. The exact treatment depends on the underlying cause and the type of symptoms you are experiencing. Most cases of spinal cord compression need surgery, but in mild cases, your doctor may decide that non-surgical therapies that reduce your pain and improve your quality of life can help. This may include medications and physical therapy. At the same time, your doctor may also recommend reduced physical activity or even immobilization to help with the pain and other symptoms.

Medications for Spinal Cord Compression

For many people, taking medication can help with the symptoms. Commonly prescribed medications for spinal cord compression may include:

  • Non-steroidal anti-inflammatory drugs (NSAIDs): This is a class of drugs that help relieve and reduce inflammation. Medications like aspirin, naproxen, and ibuprofen are common NSAIDs.(22)
  • Narcotics: These are prescribed only for a limited amount of time and only for those who are in severe pain that has not been relieved by any other treatment.
  • Oral corticosteroids: These help reduce inflammation and also alleviates the pain.
  • Epidural steroidal injections: Steroid injections are injected into the space next to your epidural spine, which is the covering of your spinal cord. These injections can help decrease local inflammation and also relieve the swelling and pain. However, steroid injections do not reduce the pressure on your spine.

Physical Therapy for Spinal Cord Compression

Apart from medications, physical therapy may also be needed for the treatment of spinal cord compression. Physical therapy exercises help reduce the pain, strengthen the neck muscles, and also improve your overall flexibility. Physical therapy also helps in maintaining your strength and endurance so that you are able to continue doing your daily tasks and activities.(23)

It is important to note that chiropractic manipulation is usually never recommended for people with spinal cord compression as this may worsen the injury or underlying cause of the compression.

Wearing a Soft Cervical Collar

Some people may also benefit from wearing a soft cervical collar. A cervical collar is a padded ring that you wrap around the neck, and it holds your neck in place. Your doctor may recommend that you wear a cervical collar to restrict the movement of your neck and allow some much-needed rest to the muscles in your neck. Such a type of collar is only used for a short time as long-term use of a cervical collar can reduce the muscle strength in the neck. (24)

Surgery for Spinal Cord Compression

If non-surgical treatment options do not relieve your symptoms, your doctor may suggest surgery. Spinal decompression surgery involves several different procedures that can help reduce the symptoms caused by compression of the spinal cord or of the nerve roots. The exact surgical procedure your doctor recommends depends on factors like what parts of the spinal cord are involved and your symptoms.

Some of the commonly used surgical techniques for treating spinal cord compression include:

  • Discectomy: This surgical technique involves the removal of a part of a disk to take the pressure off the nearby nerve roots.(25)
  • Corpectomy: A corpectomy is done to remove a part of or all the vertebral body in order to decompress the spinal cord and nerve roots. This surgical procedure is typically performed in combination with discectomy.(26)
  • Foraminotomy or foraminectomy: Both these techniques are carried out in order to expand the nerve root endings that exit the spinal cord. The procedures are performed by removing some tissue and bone. A foraminectomy involves removing quite large amounts of tissue and bone.(27)
  • Laminectomy or laminotomy: A laminotomy is done to remove the lamina, which is the bony arch of the spinal cord. During a laminectomy, the entire lamina gets removed. Removal of the lamina increases the size of the spinal canal, which helps relieve the pressure.(28)
  • Osteophyte removal: This surgical technique involves the removal of the bone spurs.

Alternative treatments like acupressure or acupuncture can also help in relieving some of your symptoms. Home care, including applying heating pads and ice packs, along with over-the-counter pain relievers, can help alleviate the pain associated with spinal cord compression. If there is a tumor that is the cause of cord compression, your doctor may prescribe radiation therapy or chemotherapy to shrink the tumor.

Conclusion

A person’s outlook is affected by the exact cause of the spinal cord compression along with the severity of symptoms. While some people tend to respond well to treatments, others do not.

Many people often ask if spinal cord compression can be prevented. However, it might not always be possible to prevent such type of compression because there are so many different causes of cord compression. Maintaining a healthy weight, eating a well-balanced diet, exercising regularly can all help reduce any added pressure on the back and also alleviate the symptoms of spinal cord compression. It is also important that you pay attention to safety rules while lifting anything heavy to prevent causing any type of injury to your spinal cord.

References:

  1. Schiff, D., 2003. Spinal cord compression. Neurologic clinics, 21(1), pp.67-86.
  2. Tarlov, I.M., Klinger, H. and Vitale, S., 1953. Spinal cord compression studies: I. experimental techniques to produce acute and gradual compression. AMA Archives of Neurology & Psychiatry, 70(6), pp.813-819.
  3. Tarlov, I.M., 1972. Acute spinal cord compression paralysis. Journal of neurosurgery, 36(1), pp.10-20.
  4. Rivlin, A.S. and Tator, C.H., 1978. Effect of duration of acute spinal cord compression in a new acute cord injury model in the rat. Surgical neurology, 10(1), pp.38-43.
  5. McDonald, J.W. and Sadowsky, C., 2002. Spinal-cord injury. The Lancet, 359(9304), pp.417-425.
  6. Kim, D., Kim, M.A., Cho, I.H., Kim, M.S., Lee, S., Jo, E.K., Choi, S.Y., Park, K., Kim, J.S., Akira, S. and Na, H.S., 2007. A critical role of toll-like receptor 2 in nerve injury-induced spinal cord glial cell activation and pain hypersensitivity. Journal of Biological Chemistry, 282(20), pp.14975-14983.
  7. Sundaresan, N., Digiacinto, G.V., Hughes, J.E., Cafferty, M. and Vallejo, A., 1991. Treatment of neoplastic spinal cord compression: results of a prospective study. Neurosurgery, 29(5), pp.645-650.
  8. Orendáčová, J., Čı́žková, D., Kafka, J., Lukáčová, N., Maršala, M., Šulla, I., Maršala, J. and Katsube, N., 2001. Cauda equina syndrome. Progress in neurobiology, 64(6), pp.613-637.
  9. Livingston, K.E. and Perrin, R.G., 1978. The neurosurgical management of spinal metastases causing cord and cauda equina compression. Journal of neurosurgery, 49(6), pp.839-843.
  10. Gitelman, A., Hishmeh, S., Morelli, B.N., Joseph Jr, S.A., Casden, A., Kuflik, P., Neuwirth, M. and Stephen, M., 2008. Cauda equina syndrome: a comprehensive review. Am J Orthop (Belle Mead NJ), 37(11), pp.556-62.
  11. Takahashi, M., Sakamoto, Y., Miyawaki, M. and Bussaka, H., 1987. Increased MR signal intensity secondary to chronic cervical cord compression. Neuroradiology, 29(6), pp.550-556.
  12. Arroyo, I.L., Barron, K.S. and Brewer Jr, E.J., 1988. Spinal cord compression by epidural lipomatosis in juvenile rheumatoid arthritis. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology, 31(3), pp.447-451.
  13. Nguyen, H.V., Ludwig, S.C., Silber, J., Gelb, D.E., Anderson, P.A., Frank, L. and Vaccaro, A.R., 2004. Rheumatoid arthritis of the cervical spine. The Spine Journal, 4(3), pp.329-334.
  14. Bouchaud-Chabot, A. and Lioté, F., 2002. Cervical spine involvement in rheumatoid arthritis. A review. Joint Bone Spine, 69(2), pp.141-154.
  15. Logue, V., 1952. Thoracic intervertebral disc prolapse with spinal cord compression. Journal of neurology, neurosurgery, and psychiatry, 15(4), p.227.
  16. Gilbert, R.W., Kim, J.H. and Posner, J.B., 1978. Epidural spinal cord compression from metastatic tumor: diagnosis and treatment. Annals of Neurology: Official Journal of the American Neurological Association and the Child Neurology Society, 3(1), pp.40-51.
  17. Bailey, P. and Casamajor, L., 1911. Osteo-arthritis of the spine as a cause of compression of the spinal cord and its roots: with reports of five cases. The Journal of Nervous and Mental Disease, 38(10), pp.588-609.
  18. Online.epocrates.com. 2021. Epocrates Online. [online] Available at: <https://online.epocrates.com/diseases/1012/Spinal-cord-compression> [Accessed 10 April 2021].
  19. Aans.org. 2021. Spinal Cord Injury – Types of Injury, Diagnosis and Treatment. [online] Available at: <https://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Spinal-Cord-Injury> [Accessed 10 April 2021].
  20. Carmody, R.F., Yang, P.J., Seeley, G.W., Seeger, J.F., Unger, E.C. and Johnson, J.E., 1989. Spinal cord compression due to metastatic disease: diagnosis with MR imaging versus myelography. Radiology, 173(1), pp.225-229.
  21. Skinner, S.A. and Transfeldt, E.E., 2009. Electromyography in the detection of mechanically induced spinal motor tract injury: observations in diverse porcine models. Journal of Neurosurgery: Spine, 11(3), pp.369-374.
  22. Hayta, E. and Elden, H., 2018. Acute spinal cord injury: A review of pathophysiology and potential of non-steroidal anti-inflammatory drugs for pharmacological intervention. Journal of chemical neuroanatomy, 87, pp.25-31.
  23. Abrahm, J.L., 2004. Assessment and treatment of patients with malignant spinal cord compression. The journal of supportive oncology, 2(5), pp.377-88.
  24. Persson, L.C., Carlsson, C.A. and Carlsson, J.Y., 1997. Long-lasting cervical radicular pain managed with surgery, physiotherapy, or a cervical collar: a prospective, randomized study. Spine, 22(7), pp.751-758.
  25. O’Laoire, S.A. and Thomas, D.G., 1983. Spinal cord compression due to prolapse of cervical intervertebral disc (herniation of nucleus pulposus): Treatment in 26 cases by discectomy without interbody bone graft. Journal of neurosurgery, 59(5), pp.847-853.
  26. Lu, J., Wu, X., Li, Y. and Kong, X., 2008. Surgical results of anterior corpectomy in the aged patients with cervical myelopathy. European Spine Journal, 17(1), pp.129-135.
  27. Kumar, G.R.V., Maurice-Williams, R.S. and Bradford, R., 1998. Cervical foraminotomy: an effective treatment for cervical spondylotic radiculopathy. British journal of neurosurgery, 12(6), pp.563-568.
  28. Ishida, Y., Suzuki, K., Ohmori, K., Kikata, Y. and Hattori, Y., 1989. Critical analysis of extensive cervical laminectomy. Neurosurgery, 24(2), pp.215-222.

Also Read: