Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Malignant Spinal Cord Compression

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In one line

·A tumor presses on the spinal cord and cuts off its signals.

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Normal physiology

·The spinal cord is a thick bundle of nerves that runs down the center of your backbone, protected by a bony tunnel made of stacked vertebrae (the small bones in your spine).

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What goes wrong

·A tumor grows into or presses on the spine bones, squeezing the spinal cord inside and blocking the signals that run through it.

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Hallmark signs

·Back pain that gets worse when lying down or at night
·Weakness in the legs
·Numbness or tingling below the level of the tumor
·Trouble controlling your bladder or bowels
·A band of pain around your chest or belly
·Trouble walking or a clumsy, unsteady gait
·Known history of cancer, especially lung, breast, prostate, kidney, or myeloma
·Loss of reflexes in the legs

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Red flags · escalate now

·New or worsening back pain in anyone with a history of cancer
·Any leg weakness, numbness, or trouble walking that comes on quickly
·Loss of bladder or bowel control (this is a true emergency — permanent damage can happen in hours)
·Back pain that is worse at night or when lying flat, especially if pain medicine doesn't help

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Workup

·MRI of the entire spine with gadolinium contrast
·Plain X-ray of the spine (if MRI is not immediately available)
·Complete blood count (CBC)
·Serum calcium
·Prostate-specific antigen (PSA) in men, or tumor markers (CA-125, CEA, CA 19-9) if cancer type is unknown
·Red blood cell (Erythrocyte) sedimentation rate (ESR) or C-reactive protein (CRP)

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Treatment

·Dexamethasone 10 mg IV bolus immediately, then 4 mg IV or by mouth every 6 hours
·Emergency MRI of the entire spine with gadolinium within 24 hours (ideally within hours)
·Radiation therapy to the tumor site, started within 24 hours if the patient can still walk or move legs
·Emergency decompression surgery (laminectomy or vertebrectomy) if the patient is paralyzed, rapidly worsening, or the spine bone is unstable
·Systemic cancer treatment—chemotherapy, hormone therapy, or immunotherapy—chosen based on the type of cancer
·Bone-strengthening drugs—zoledronic acid 4 mg IV every 3–4 weeks or denosumab 120 mg subcutaneous every 4 weeks
·Bladder catheterization if urine retention, bowel program if constipation or incontinence, and physical therapy as soon as the cord pressure is relieved

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NCLEX trap

·Back pain that worsens at night in someone with a history of cancer is malignant spinal cord compression until you prove otherwise. Order an MRI of the spine today — within hours, not days. Fast action saves the spinal cord from permanent damage because the tumor is squeezing nerves right now.
·In malignant spinal cord compression, you must check if the spinal cord is being squeezed (look for weak legs, numb patches, trouble holding pee or poop) before you treat the pain. Pain medicine without a diagnosis delays the real fix — steroids, radiation, or surgery — and lets nerves die while you wait.
·MRI is the only test that shows if the spinal cord is being squeezed and exactly where the tumor is. Get it now — within hours. In malignant spinal cord compression, every hour of delay means more nerve cells die from the pressure, and damage can become permanent.
·Weak legs from malignant spinal cord compression mean the tumor is squeezing the spinal cord hard enough that movement signals can't get through. The longer the tumor presses, the more permanent the damage. You need steroids, radiation, or surgery right away to take the pressure off before the nerves die for good.
·Give dexamethasone IV immediately to shrink the swelling around the tumor, then arrange radiation or surgery. In malignant spinal cord compression, steroids buy time for the nerves by reducing pressure fast — within minutes to hours — while you wait for the tumor-shrinking treatment to start working.
·Always ask cancer patients with back pain: Can you move your legs? Do your legs feel numb or tingly? Can you hold your pee and poop, or are you leaking? These questions catch malignant spinal cord compression before it becomes permanent paralysis.

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