Spinal Cord Compression Causes and Clinical Manifestations

Degenerative Diseases

Spondylotic myelopathy is the most common cause of chronic spinal cord compression, predominantly affecting the cervical spine, with contributing factors including disc herniations, spinal degenerative changes, and osteophyte formation, according to the American College of Radiology 1, 2, 3
Clinical manifestations of spondylotic myelopathy include progressive weakness, gait disturbance, sensory deficits, loss of fine motor coordination, and bladder dysfunction in advanced cases 1

Metastatic epidural spinal cord compression (MESCC) affects approximately 2.5-5% of all cancer patients, with back pain being the earliest and most common symptom, occurring in 88-90% of patients 4
MESCC can result from extradural and intradural extramedullary tumors, and clinical manifestations include back pain, sensory loss, radicular pain, bladder and bowel dysfunction, and motor weakness progressing to paralysis if untreated 2, 3, 4

Epidural abscess causes acute extrinsic compression of the spinal cord, presenting with severe back pain, fever, and rapidly progressive neurologic deficits 2, 3
Chronic infections, such as tuberculosis, schistosomiasis, and HIV vacuolar myelopathy, can also cause spinal cord compression, with clinical manifestations including progressive weakness, sensory loss, and bladder and bowel dysfunction 2

Multiple sclerosis (MS) involves the spinal cord in 80-90% of patients, most commonly the cervical cord, with clinical manifestations including incomplete transverse myelitis, Lhermitte's sign, asymmetric motor and sensory deficits, and bladder urgency and frequency 2
Neuromyelitis optica (NMO) is characterized by longitudinally extensive transverse myelitis, with clinical manifestations including severe bilateral motor weakness, sensory level, and bladder and bowel dysfunction 2

Spinal cord ischemia results from atheromatous disease or complication of aortic surgery, presenting with acute onset myelopathy, sudden onset of flaccid paralysis, dissociated sensory loss, and bladder and bowel dysfunction 3
Spinal dural arteriovenous malformations/fistulas cause progressive myelopathy through venous hypertension, with clinical manifestations including progressive lower extremity weakness, sensory disturbances, and symptoms worsening with exercise or Valsalva 2

MRI of the entire spine is the gold standard for evaluating spinal cord compression, offering superior soft-tissue resolution and multiplanar capability, according to the American College of Radiology and the National Comprehensive Cancer Network 1, 5, 6
Urgent spinal MRI is mandatory when neurologic symptoms develop, and imaging the entire spine is recommended as multilevel involvement is common 3, 5, 6