spinal cord compression

Spinal cord compression occurs when external pressure is applied to the spinal cord, causing mechanical disruption of neural pathways and potentially irreversible neurological damage. Common causes include malignancy (breast, lung, prostate cancers with vertebral metastases), epidural abscesses, herniated discs, spinal stenosis, and trauma. Pathophysiology involves direct mechanical compression leading to ischemia, inflammation, and neural tissue damage. Clinical presentation follows a predictable pattern: initial back pain (often the first symptom), followed by motor weakness in a dermatomal distribution, sensory loss, and finally autonomic dysfunction (bowel/bladder incontinence, sexual dysfunction). The level of compression determines the pattern of deficits - cervical compression causes quadriplegia, thoracic causes paraplegia, and lumbar affects lower extremities and sphincters. Emergency MRI is the gold standard for diagnosis. Treatment depends on etiology but may include high-dose corticosteroids, surgical decompression (laminectomy), radiation therapy for malignant causes, or antibiotics for infectious causes. Prognosis is time-dependent - patients who are ambulatory at presentation have better outcomes than those who are already paraplegic.