Spinal cord compression — MSCC vs cauda equina vs abscess

MSCC. Cancer history, progressive pain (night), UMN signs if above conus, sensory level. Dexamethasone loading per the local protocol before MRI; MRI whole spine; direct decompressive surgery plus radiotherapy beats radiotherapy alone in selected single-level disease (Patchell).^[1][2]

Cauda equina. LMN pattern: saddle anaesthesia, bilateral sciatica, retention/overflow, reduced anal tone, often large central disc. Urgent lumbosacral MRI and surgical decompression within 24–48 h. Steroids used similarly when cord/conus also threatened.^[3]

Epidural abscess. Back pain ± fever ± deficit triad often incomplete; raised CRP; IVDU/diabetes. MRI whole spine; blood cultures; surgical drainage + IV antibiotics (vancomycin + third-generation cephalosporin or pip-tazo). Steroids controversial — specialist call; do not use steroids as sole therapy.^[3]

Shared ED moves. Document neurology, protect spine, reverse coagulopathy if haematoma, parallel specialty calls, do not image only the painful level when malignancy/abscess suspected.^[3]