Spinal cord compression—also called cervical spondylotic myelopathy (CSM)— is caused by any condition that puts pressure on the spinal cord.Symptoms may develop suddenly or gradually and may include pain or stiffness in the neck or back, balance issues, or a burning pain in the arms or legs.
Spinal cord compression can occur anywhere in the spine, including in the neck (cervical spine) and the torso (thoracic spine).The condition is treatable, and treatment can include supportive therapies, medication, and surgery.
This article explores the causes and symptoms of spinal cord compression, as well as how it’s diagnosed and treated.
Spinal Cord Compression Symptoms
Depending on the cause of spinal cord compression, symptoms may develop slowly or quickly.Some injuries may cause immediate symptoms.Some health conditions—such as a tumor or infection—may cause symptoms that come on gradually over days or even weeks. Wear and tear of the spine takes years to develop.
Symptoms depend on where the pressure is located in the spinal cord. Pain is often the first symptom and more than 90%of people with spinal cord compression experience pain.
Common symptoms of spinal cord compression include:
- Balance issues
- Pain and stiffness in the neck, upper back, or lower back
- Burning pain that spreads into arms, buttocks, or down the legs, called sciatica
- Numbness, weakness, and/or cramping in the hands, arms or legs
- Loss of feeling in the feet
- Hand coordination problems
- Weakness of one foot or both feet that results in limping
The spinal cord is the bundle of nerves running down the middle of the back. It sends send messages back and forth from the brain to muscles and soft tissues.
As the spinal cord travels down the back, it is protected by the vertebral column, which is a stack of bones that hold the body upright. The nerves of the spinal cord run through various openings between the vertebrae and then to the muscles.
Spinal cord compression may affect fine motor skills and coordination.This includes the coordination of fine muscles and daily activities, such as handwriting or buttoning a shirt.Spinal cord compression may also affect gait (how a person walks), reflexes, range of motion, and muscle movement.
Cauda Equina Syndrome
Pressure on the lower back can cause more serious symptoms, characteristic of a condition called cauda equina syndrome.Cauda equina syndrome is an emergency and warrants a trip to the emergency room.
Symptoms include:
- Loss of bladder or bowel control
- Severe, increasing numbness between the legs, inner thighs, and back of the legs—a symptom known as saddle anesthesia
- Severe pain and weakness that is spreading into one or both legs, making it harder to move around (even while sitting) or walking
In people with cauda equina syndrome, compression is confined to the lumbar spine (low back) below the conus medullaris (the lower part of the spinal cord).
You do not need to experience all the signs of cauda equina syndrome for a diagnosis to be made or for you to seek out immediate medical attention.Immediate medical attention is important so as to prevent lasting damage and possible permanent paralysis of the legs.
Diagnosing Spinal Cord Compression
To make a diagnosis, your healthcare provider will ask questions about your symptoms and do a complete physical exam.The exam will look for signs that indicate spinal compression, including abnormal reflexes, weakness, and loss of feeling in the legs and arms.
Tests that may help to make a diagnosis of spinal cord compression include:
- Spine X-rays:X-rays may show bone spurs pushing against the spinal nerves.They may also show abnormal alignment of the spine.
- Special imaging:A computed tomography (CT) scan or magnetic resonance imaging (MRI) scan can give a more detailed view of the spinal cord and tissues surrounding it.
- Additional studies:Your healthcare provider may also want to do a myelogram, a special CT scan that involves injecting dye in the spinal column, or an electromyography, an electrical test that measures muscle activity.
What Causes Spinal Cord Compression?
Spinal cord compression has numerous possible causes.In some cases, however, compression can come on suddenly and no known cause can be determined.
Potential causes of spinal cord compression include:
Degenerative Conditions
Degenerative disc disease is a normal part of aging.This occurs when the disks of the vertebrae in your neck or back wear out.
Rheumatoid arthritis
Rheumatoid arthritis (RA) is a disease where the immune system attacks its own healthy tissues. In RA, immune cells attack the synovium, the thin membrane lining the joints. This process is called inflammation, and as the synovium becomes inflamed, you will feel pain and stiffness.
Long-term inflammation in the cervical spine can destroy the facet joints. Your facet joints are the joints in the spine that make your back flexible and allow you to bend and twist. When this occurs, the upper vertebra slides on top of the lower vertebra, causing compression.
Disk Herniation
A disk herniates when its jelly-like center—called the nucleus pulposus—pushes against its outer ring (annulus fibrosus).If the disk is severely worn or injured, the nucleus may squeeze all the way out.When a herniated disk bulges out towards the spinal cord, it puts pressure on the spinal cord, causing compression.Disk herniation can also occur with lifting, pulling, bending, and twisting movements.
Injuries
Any injury to the spine—such as a car accident, sports injury, or fall—can lead to spinal cord compression.
Bone Spurs
As a person ages, the disks in their spine start to lose height and begin to bulge. They also lose water content, dry out, and become stiff.The result is the collapse of disk space and loss of space height.
When this happens, the vertebrae move closer together and the body responds to a collapsed disk by forming bone spurs in an attempt to strengthen the disk.Bone spurs cause stiffness and narrowing of the spinal canal and start to compress the spinal cord.
Tumors
Cancerous and benign (noncancerous) tumors sometimes grow in the space near the spinal cord.The tumor may put pressure on the cord, causing compression.
Spinal tumors potentially can cause paralysis and neurological problems.Sometimes, these growths are life-threatening and can lead to permanent disability.
Treatment is necessary for most tumors and may include surgery and medications. If a tumor is cancerous, radiation therapy and/or chemotherapy are recommended.
Risk Factors
Anyone can injure their spinal cord or develop a health condition that leads to spinal cord compression.While injury is the main source, some causes are also risk factors that may increase the risk for the development of spinal cord compression.
For example, poor lifting practices can increase a person’s risk of injuring their neck or back, leading to spinal cord compression. Furthermore, people who have osteoarthritis and inflammatory arthritis have an increased risk of developing spinal cord compression.
Prevalence
Research shows that there are around 18,000 traumatic spinal cord injuries every year in the United States. Spinal cord injury incidence (i.e., newly diagnosed cases) in 2019 is estimated to have been 909,000 cases per one million people globally and 54 cases per million in the U.S.
Men account for more than 80% of all spinal cord injuries, and close to 90% of these are sports-related, according to the American Association of Neurological Surgeons.Both genders are equally affected when it comes to automobile accidents, falls, and gunshots.Incidences in women are often related to medical and surgical complications.
How Is Spinal Cord Compression Treated?
Treatment for spinal cord compression depends on the cause and the type of symptoms you are experiencing.
Many cases of spinal cord compression do require surgery, but in mild cases, your healthcare provider may recommend non-surgical therapies to decrease pain and improve your quality of life, such as medication and physical therapy.
Medications
For many people, medications can help to improve symptoms. This includes:
- Non-steroidal anti-inflammatory medications (NSAIDs): NSAIDs, such as ibuprofen, aspirin, and naproxen, can help relieve and reduce inflammation.
- Oral corticosteroids: Oral corticosteroids can help relieve pain and reduce inflammation.
- Epidural steroid injections: Steroid injections that are injected in the space next to the epidural spine (the covering of the spinal cord) can help reduce local inflammation and relieve pain and swelling.Injections will not relieve pressure on the spine.
- Narcotics:Narcotics are prescribed for limited periods and only for people whose pain is severe enough and has not been relieved by other therapies.
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Physical Therapy
Physical therapy exercises can help with pain, strengthening neck muscles, and increasing flexibility.It can also help with maintaining strength and endurance so that you are better able to go about your daily activities.Chiropractic manipulation is not recommended for people with spinal cord compression.
Soft Cervical Collar
A cervical collar is a padded ring that wraps around the neck and holds it in place.Your healthcare provider may recommend a cervical collar to limit neck motion and allow the muscles in your neck to rest.A short collar is only recommended for short-term wear because long-term use may reduce muscle strength in the neck.
Surgery
When non-surgical treatment does not relieve symptoms, your healthcare provider may talk to you about whether surgery can help.Spinal decompression surgery refers to different procedures to relieve symptoms of compression on the spinal cord or nerve roots. What your healthcare provider recommends will depend on many factors, including symptoms experienced and what parts of the spinal cord are involved.
Surgical options include:
- Discectomy: This procedure involves removing a portion of a disk to relieve pressure off nearby roots.
- Corpectomy: A corpectomy involves removing part or all the vertebral body to decompress the spinal cord and nerves.This procedure is usually performed with some form of discectomy.
- Laminotomy or laminectomy: A laminotomy involves removal of the lamina, the bony arch of the spinal cord. With a laminectomy, the entire lamina is removed.Removing the lamina increases the size of the spinal canal to relieve pressure.
- Foraminotomy or foraminectomy: Both of these procedures are done to expand nerve root endings that exit the spinal cord by removing some bone and tissue. A foraminectomy involves removing large amounts of bone and tissue.
- Osteophyte removal: This procedure involves the removal of bone spurs.
