Spinal cord compression is an oncological emergency that occurs when a vertebral metastasis or a tumour affecting the spine compresses the spinal cord or the nerve roots. If not diagnosed and treated promptly, it can cause permanent neurological damage, including loss of mobility and impairment of bladder or bowel control.

Although any cancer can cause spinal metastases, spinal cord compression is more common in people with breast, lung or prostate cancer, as well as in patients with multiple myeloma and certain lymphomas.

Symptoms and Warning Signs

Symptoms may develop gradually or progress rapidly. The most common include:

• Persistent back or neck pain, especially if it worsens at night or with movement.
• Pain that radiates into the arms, chest or legs.
• Weakness or loss of strength in the limbs.
• Numbness, tingling or loss of sensation in the hands, feet, or around the buttocks and perineal area.
• Difficulty walking, unsteadiness or a sensation that the legs are giving way.
• Changes in bladder or bowel control, such as urinary retention, incontinence or new-onset constipation.

What to Do If Spinal Cord Compression Is Suspected

If any of these symptoms develop, particularly in someone with a history of cancer, urgent medical assessment is essential, as early diagnosis and treatment increase the chances of preserving neurological function and mobility.

The investigation of choice is usually an urgent MRI scan of the entire spine.

Immobilisation should not be applied routinely to all patients. Current guidelines recommend assessing whether movement restrictions are necessary when spinal instability is suspected or when significant neurological symptoms are present, while avoiding prolonged immobilisation whenever possible.

Treatment

Treatment depends on the cause of the compression, its location, the patient's overall health and the prognosis of the cancer. It may include:

• Corticosteroids (usually dexamethasone) to reduce swelling and pressure on the spinal cord.
• Radiotherapy.
• Spinal decompression surgery and/or stabilisation procedures in selected patients.
• Systemic cancer treatment, such as chemotherapy, hormone therapy, targeted therapies or immunotherapy, depending on the tumour type.

Rehabilitation and Follow-up Care

After treatment, care requirements will depend on the degree of neurological recovery, pain control and the level of mobility achieved.

A multidisciplinary team, including oncology specialists, rehabilitation physicians, physiotherapists, nurses and other healthcare professionals, will work together to plan ongoing care, support functional recovery and maximise quality of life.