EM · Spinal cord compression
Spinal cord compression
Also known as Malignant spinal cord compression · MSCC · Epidural spinal cord compression
Spinal cord compression — the time-critical neurological emergency from the extrinsic compression of the spinal cord by the tumour, the disc, the abscess or the haematoma; the clinical (the progressive back pain, the motor weakness, the sensory level, the bladder and bowel dysfunction); the urgent MRI whole spine within 4 to 6 hours; the dexamethasone 10 mg IV loading then 4 mg every 6 hours; the neurosurgical and the oncological referral; and the time-to-treatment determining the ambulatory outcome. ACEM-primary, globally tagged.
Checked against its sources on 3 Sept 2026
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Target exams
Red flags
- Any patient with a known cancer and the new back pain has the spinal cord compression until the MRI proves otherwise
- The motor weakness progresses rapidly — the ambulatory status at the presentation determines the ambulatory outcome
- The MRI whole spine (not just the symptomatic level) — the skip lesions are common in the malignancy
- The dexamethasone 10 mg IV is given before the MRI if the clinical suspicion is high
Meet the patient
A 62-year-old woman with metastatic breast cancer arrives with three weeks of progressive lower-thoracic back pain that wakes her at night, and two days of difficulty walking. On examination she has a sensory level at T10, grade 3 of 5 weakness in both legs, hyperreflexia and upgoing plantars; her blood pressure is 110 over 70.[1]
Two questions decide her next hour, and they decide every cord-compression presentation: is the cord compressed? (the MRI answers within hours) and can I decompress in time? (the 24-hour clock answers over the day). Hold those two and everything below slots into place.[1]
References4ShowHide
- [1]Singer E, et al. Initial management and disposition of metastatic spinal cord compression in the emergency department: a review of the literature Ann Med, 2025.PMID 41033840
- [2]Patel DA, Campian JL Diagnostic and Therapeutic Strategies for Patients with Malignant Epidural Spinal Cord Compression Curr Treat Options Oncol, 2017.PMID 28795286
- [3]Patchell RA, Tibbs PA, Regine WF, et al. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial Lancet, 2005.PMID 16112300
- [4]Bilsky MH, Laufer I, Fourney DR, et al. Reliability analysis of the epidural spinal cord compression scale J Neurosurg Spine, 2010.PMID 20809724