Spinal cord compression

The spine functions to carry loads and to allow a wide range of motion while protecting the spinal cord. Spinal cord compression may result from a number of pathological processes and is often a medical emergency, which may result in devastating outcomes such as permanent disability and even death. In developed countries, traumatic spinal cord injury (TSCI) occurs predominantly in males aged 18-32 years with a second peak occurring among males and females aged over 65 years. Although the reporting of nontraumatic spinal cord injury (NTSCI) is not well documented, the overall incidence of NTSCI is also expected to increase as the population ages. This chapter discusses the causes of spinal compression due to tumor, infection, degenerative disease, and trauma and the management of the conditions. The guiding principle for treatment is decompression of the spinal cord with appropriate stabilization before irreversible neurological damage occurs. Modalities for treatment include surgery, radiation, minimally invasive percutaneous procedures, and pharmacological therapy. The time period within which a compressed spinal cord must be decompressed depends on the etiology of the compression. Symptomatic spinal cord compression due to tumor and infection, as well as acute trauma, should prompt urgent neurosurgical consultation, and the implementation of treatment should be sought ideally within 24 hours of presentation. Chronic cord compression due to degenerative disease, however, does not appear to require immediate aggressive management with treatment usually initiated based on progression of symptoms.