Symptoms related to spinal cord compression vary and depend on the extent of the compression present. Mild compression may lead to a prickling or tingling sensation, backache, muscle weakness and erectile dysfunction. The painful sensation of the back may extend to the back of the leg and reflexes may be affected too, either in terms of weakened or exaggerated reflexes.

If the compressive cause is not removed or repaired, continual pressure exerted on the spine can lead to more severe symptoms, such as urinary retention or loss of bowel and bladder control, considerably weakened muscles and numbness. The most severe symptoms that can arise from SCC are paralysis and a complete loss of sensory function.

The suspicion of spinal cord compression must be followed by prompt workup, due to the devastating and potentially irreversible consequences of paralysis and sensory loss.

The first step towards a diagnosis includes a plain radiograph of the spinal column, in order to detect fractured vertebral bodies or a dislocation [7]. Following the radiographic imaging, a magnetic resonance imaging (MRI) scan is the test of choice in order to illustrate the spinal cord and its surrounding structures. Herniated discs, tumors, abscesses or hematomas can all be detected via MRI; if the procedure cannot be performed for lack of availability, a myelography can be done instead. A potential infection of the spinal tract can be ruled out via a lumbar puncture. In the case that a tumor is discovered, further evaluation including a biopsy will be required, in order to confirm malignancy [8].

Partial or acute spinal cord compression must be addressed at once; successful identification of the condition and proper treatment will relieve the spinal cord of the extreme pressure and sensory and/or motor function will be restored, since irreversible damage to the nerves requires time in order to develop. Surgical intervention is the treatment of choice in such cases.

Apart from surgery, SCC induced by other causes may require different types of treatment as well. Should a hematoma or tumor be the cause of SCC, dexamethasone or methylprednisolone may help to restore the amount of pressure exerted on the spinal cord [9]. Corticosteroids target the inflammation caused by the tumor and the latter can then be surgically excised or treated with radiation therapy [10] [11].

Abscesses can cause extra pressure to the spinal cord; if that is the cause, surgical excision is the method of choice, followed by the administration of antimicrobial agents [12]. In the absence of any neurological sequelae, the abscess open link may be solely drained, possibly followed by antibiotic coverage. Surgical drainage is also the method most doctors prefer in cases of hematomas. Should an individual suffer from a coagulation disorder, vitamin K injections and plasma transfusions are opted for, in order to reduce the risk of bleeding and hematoma recurrence.

With regard to the most common cause of SCC, trauma, only a small percentage of the patients are expected to experience a relapse, due to a certain instability of the spinal cord or because they do not refrain from the activity that caused the traumatic injury. 1/3 of the patients who experience loss of limb motion are expected to regain mobility and almost 80% of the individuals will require urinary catheterization for the rest of their lives [5].

SCC that is a result of malignancy is expected to reappear at a rate of up to 10% and when the condition arises due to cauda equina syndrome, recurrence is exhibited at a rate of up to 15% [6].

Spinal cord compression has multiple etiologic factors [2]. The most common cause is cancer, and particularly metastatic cancer usually originating from the lungs, brain, prostate or lymphatic tissue. A tumor that originally appears on the spine can also cause compression, but this is not usually observed in daily clinical practice. Another common cause is osteoporosis, which leads to frequent fractures of the skeleton; the dislocated bones can either lead to compression or exacerbate an already existing case of compression.

Secondarily, any mass or lesion in the vicinity of the spine can put pressure on the spinal cord. For these reasons, hematomas and abscesses pose a threat to the functionality of the spinal cord. Hematomas can arise as a result of anti-coagulant medications, arteriovenous malformations or congenital deficiency of clotting factors. Herniated discs can also press the spinal cord, as can any type of dysregulated growth of the skeleton, such as cervical spondylosis. Fibrosis of the connective tissue that envelopes the spinal cord can also restrain the cord itself and cause neurological symptoms due to compression.

Depending on the causes, spinal compression can either appear acutely and suddenly, or develop in a more gradual fashion over a longer period of time.

Spinal cord compression is a condition that is frequently diagnosed on an international level. Nevertheless, scarce data is available concerning its prevalence worldwide and the numbers presented here are estimations obtained from USA studies. According to these studies, the prevalence of SCC amounts to 4 per 100,000 individuals per year [3]. and the relative majority of the affected patients belong to the age group of 16 to 30 years old [4]. It is believed that the frequency of SCC has been on a steady rise during the past years, with trauma being the most common cause of acutely arising spinal cord compression.

Extending from the foramen magnum to the first two lumbar vertebrae, the spinal cord consists of grey and white matter, encased within a sac of three layers of meninges for reasons of protection. The innermost membrane is the pia mater and the middle membrane is the arachnoid mater; between the two, in the space called the subarachnoid space, the cerebrospinal fluid flows, providing minimal friction and additional protection to the spinal cord. On the external part of the dura, which is the outermost of the three meninges, the skeletal vertebral column encloses the spinal cord and the meninges.

At various levels in the route of the spinal cord, nerve roots serving both motor and sensory functions enter the structure, alongside vessels that provide the necessary perfusion. Any cause that leads to an increased amount of pressure to the cord, nerves and vessels can lead to neurological sequelae, such as tingling sensations, inability to feel temperature, abnormal pain sensations and even motor dysfunction and paralysis.

Acute spinal cord compression is most frequently caused by trauma or herniated discs. Fractured vertebral bodies and spinal subluxation can also lead to the same clinical picture. The condition can also arise in a more slow fashion, due to a tumor, degeneration or infection; these are the chronic types of SCC. Irrespective of the cause, the common denominator between both acute and chronic SCC is the loss of spinal cord and nerve root function. Any type of compressive injury to the vascular system responsible for the perfusion of the spinal cord also causes the same symptoms: the corticospinal and spinocerebellar tracts are the two most prone to compressive malfunction.

Concerning the occupations that are accompanied by an augmented risk of sustaining traumatic injuries of the spinal cord or disc herniation, adequate measures have to be taken by employers in order to educate the employees regarding self-protection and safe practice. Adequate safety measures should also be provided for by employers, such as restraint systems. Jobs with a such a higher risk include:

• Firefighters
• Military personnel
• Professional drivers
• People employed in the agriculture
• Seamen
• Construction workers

Any type of recreational activity that is organized should also abide by the same rules.

Compression of the spinal cord is a condition in which the spinal cord is subject to an abnormal amount of pressure.

The most common cause of spinal cord compression (SCC) is malignancy. In fact, 1 out of 20 cancer patients do exhibit this condition as a complication. Compression of the spine and, subsequently, spinal cord, is the second most common complication stemming from brain cancer [1]. There are two distinct pathways by which spinal cord compression induced by malignancy can occur. The first one involves a primary tumor of the spine, wherein the initial location of the cancerous tumor is on the spine itself, therefore exerting excessive pressure on the nervous tissue. A second pathway is metastatic cancer, wherein particularly malignancies of the lungs, prostate and breast have increased possibility of metastasizing to the spinal cord and pressing the nerves and roots. The first type of spinal cord compression, caused by a primary tumor of the spine, is termed malignant spinal cord compression and the latter is termed metastatic spinal cord compression.

Except for malignant causes, various other conditions can subject the spinal cord to increased pressure and related sequelae, including infectious diseases, spine trauma, hematomas, abscesses and osteoporotic damage.

The diagnosis of spinal cord compression can be achieved via a radiographic depiction of the spine, that will help to detect potential fractures, and a magnetic resonance imaging scan, that can delineate various tissue alterations in the vicinity of the spine, such as a hematoma, a tumor or a herniated disc. Treatment depends on the cause and may involve surgery, radiation therapy, chemotherapy or drainage. Treatment should be as prompt as possible, in order to prevent long-lasting pressure from being exerted on the spine, which will inadvertently lead to nerve damage that may be irreversible.

The spinal cord is a thin column that is made up of gray and white matter, exactly like the brain. It extends from the lower parts of the skull until the lumbar region and is encased in three membranes, a sac containing fluid and the spinal column, which consists of the vertebral skeleton. All three structures protect the vulnerable spinal cord from injuries, pressure and friction.

The spinal cord is a valuable organ, because it is responsible for sensory and motor functions. Nerves penetrate various locations of the organ and transmit vital information concerning movement and sensations (temperature, touch, pain, etc.). It should by all means be protected, because damage to it may be irreversible and can lead to devastating consequences and disability.

Various circumstances lead to an increased amount of pressure sustained by the spinal cord. Traumatic injuries, herniated discs, tumors, collections of pus or blood around the spinal region, as well as infection of the spine and fractured vertebrae can all lead to the condition known as spinal cord compression. Depending on the degree of compression, a person may experience strange tingling sensations, lose the ability to feel temperature or pain, feel numb and, in extreme cases, lose the ability to move and control their bladder and bowel.

The condition is diagnosed via X-rays of the back, and MRI or myelography and a lumbar puncture, if necessary. Treatment may be surgical or pharmacological and the results depend on the cause of the compression and the time that has passed between its development and the point of therapy.

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