An Overview of Spinal Cord Compression

Spinal cord compression—also called cervical spondylotic myelopathy (CSM)— is caused by any condition that puts pressure on the spinal cord. The spinal cord is the bundle of nerves running down the middle of the back. It sends send messages back and forth from the brain to muscles and soft tissues. As the spinal cord travels down the back, it is protected by the vertebral column, which is a stack of bones that hold the body upright. The nerves of the spinal cord run through various openings between the vertebrae and then to the muscles.

Spinal cord compression can occur anywhere in the spine, including in the neck (cervical spine) and the torso (thoracic spine). Symptoms of spinal cord compression may develop suddenly or gradually. The condition is treatable, and treatment can include supportive therapies, medication, and surgery. 

Symptoms 

Depending on the cause of spinal cord compression, symptoms may develop slowly or quickly. Some injuries may cause immediate symptoms. Some health conditions—such as a tumor or infection—may cause symptoms that come on gradually over days or even weeks. Wear and tear of the spine takes years to develop.

Common symptoms of spinal cord compression include:

• Balance issues
• Pain and stiffness in the neck, upper back or lower back
• Burning pain that spreads into arms, buttocks, or down the legs, called sciatica
• Numbness, weakness, and/or cramping in the hands, arms or legs
• Loss of feeling in the feet
• Hand coordination problems
• Weakness of one foot or both feet that results in limping

Spinal cord compression may affect fine motor skills and coordination. This includes the coordination of fine muscles and daily activities, such as handwriting or buttoning a shirt. Spinal cord compression may also affect gait (how a person walks), reflexes, range of motion, and muscle movement.

Cauda Equina Syndrome 

Pressure on the low back can cause more serious symptoms, characteristic of a condition called cauda equina syndrome. Cauda equina syndrome is an emergency and warrants a trip to the emergency room.

Symptoms include: 

• Loss of bladder or bowel control
• Severe, increasing numbness between the legs, inner thighs, and back of the legs—a symptom known as saddle anesthesia
• Severe pain and weakness that is spreading into one or both legs, making it harder to move around (even while sitting) or walking

In people with cauda equina syndrome, compression is confined to the lumbar spine (low back) below the conus medullaris (the lower part of the spinal cord).

Causes

Spinal cord compression has numerous possible causes. In some cases, however, compression can come on suddenly and no known cause can be determined.

Potential causes of spinal cord compression include: 

Degenerative conditions: Degenerative disc disease is a normal part of aging. This occurs when the disks of the vertebrae in your neck or back wear out. 

Rheumatoid arthritis: Rheumatoid arthritis (RA) is a disease where the immune system attacks its own healthy tissues. In RA, immune cells attack the synovium, the thin membrane lining the joints. This process is called inflammation, and as the synovium becomes inflamed, you will feel pain and stiffness. Long-term inflammation in the cervical spine can destroy the facet joints. Your facet joints are the joints in the spine that make your back flexible and allow you to bend and twist.  When this occurs, the upper vertebra slides on top of the lower vertebra, causing compression.

Disk Herniation: A disk herniates when its jelly-like center—called the nucleus pulposus—pushes against its outer ring (annulus fibrosus). If the disk is severely worn or injured, the nucleus may squeeze all the way out. When a herniated disk bulges out towards the spinal cord, it puts pressure on the spinal cord, causing compression. Disk herniation can also occur with lifting, pulling, bending and twisting movements. 

Injuries: Any injury to the spine—such as a car accident, sports injury, or fall—can lead to spinal cord compression.     

Bone spurs: As a person ages, the disks in their spine start to lose height and begin to bulge. They also lose water content, dry out and become stiff. The result is collapse of disk space and loss of space height. When this happens, the vertebrae move closer together and the body responds to a collapsed disk by forming bone spurs in an attempt to strengthen the disk. Bone spurs cause stiffness and narrowing of the spinal canal and start to compress the spinal cord.

Tumors: Cancerous and benign (noncancerous) tumors sometimes grow in the space near the spinal cord. The tumor may put pressure on the cord, causing compression.

Treatment is necessary for most tumors and may include surgery and medications. If a tumor is cancerous, radiation therapy and/or chemotherapy are recommended. 

Risk Factors 

Anyone one can injure their spinal cord or develop a health condition that leads to spinal cord compression. While injury is the main source, some causes are also risk factors that may increase risk for the development of spinal cord compression. 

For example, poor lifting practices can increase a person’s risk for injuring their neck or back, leading to spinal cord compression. Furthermore, people who have osteoarthritis and inflammatory arthritis have an increased risk for developing spinal cord compression.

Prevalence

Research shows that there are around 11,000 traumatic spinal cord injuries every year in the United States. Global prevalence is estimated to up 1,298 per one million people yearly. More of half of the incidences of spinal cord compression are in people ages 16 to 30. It seems that spinal cord compression incidences have been increasing over the past 10 years, but the incidences of compression have likely not changed.

Men account for more than 80% of all spinal cord injuries, and close to 90% of these are sports-related, according to the American Association of Neurological Surgeons. Both genders are equally affected when it comes to automobile accidents, falls, and gunshots. Incidences in women are often related to medical and surgical complications.

Diagnosis

To make a diagnosis, your healthcare provider will ask questions about your symptoms and do a complete physical exam. The exam will look for signs that indicate spinal compression, including abnormal reflexes, weakness, and loss of feeling in the legs and arms. 

Tests that may help to make a diagnosis of spinal cord compression include:          

Spine X-rays: X-rays may show bone spurs pushing against the spinal nerves. They may also show abnormal alignment of the spine.

Special imaging: A computed tomography (CT) scan or magnetic resonance imaging (MRI) scan can give a more detailed view of the spinal cord and tissues surrounding it.

Additional studies: Your healthcare provider may also want to do a myelogram, a special CT scan that involves injecting dye in the spinal column, or an electromyography, an electrical test that measures muscle activity. 

Treatment

Treatment for spinal cord compression depends on the cause and the type of symptoms you are experiencing. 

Many cases of spinal cord compression do require surgery, but in mild cases, your healthcare provider may recommend non-surgical therapies to decrease pain and improve your quality of life, such as medication and physical therapy.

Medications 

For many people, medications can help to improve symptoms. This includes: 

Non-steroidal anti-inflammatory medications (NSAIDs): NSAIDs, such as ibuprofen, aspirin, and naproxen, can help relieve and reduce inflammation. 

Oral corticosteroids: Oral corticosteroids can help relieve pain and reduce inflammation.

Epidural steroid injections: Steroid injections that are injected in the space next to the epidural spine (the covering of the spinal cord) can help reduce local inflammation and relieve pain and swelling. Injections will not relieve pressure on the spine.

Narcotics: Narcotics are prescribed for limited periods and only for people whose pain is severe enough and has not been relieved by other therapies. 

Physical Therapy

Physical therapy exercises can help with pain, strengthening neck muscles, and increasing flexibility. It can also help with maintaining strength and endurance so that you are better able to go about your daily activities. Chiropractic manipulation is not recommended for people with spinal cord compression. 

Soft Cervical Collar 

A cervical collar is a padded ring that wraps around the neck and holds it in place. Your healthcare provider may recommend a cervical collar to limit neck motion and allow the muscles in your neck to rest. A short collar is only recommended for short-term wear because long-term use may reduce muscle strength in the neck.

Surgery 

When non-surgical treatment does not relieve symptoms, your healthcare provider may talk to you about whether surgery can help. Spinal decompression surgery refers to different procedures to relieve symptoms of compression on the spinal cord or nerve roots. What your healthcare provider recommends will depend on many factors, including symptoms experienced and what parts of the spinal cord are involved.

Surgical options include:

Discectomy: This procedure involves removing a portion of a disk to relieve pressure off nearby roots.

Corpectomy: A corpectomy involves removing part or all the vertebral body to decompress the spinal cord and nerves. This procedure is usually performed with some form of discectomy.

Laminotomy or laminectomy: A laminotomy involves removal of the lamina, the bony arch of the spinal cord. With a laminectomy, the entire lamina is removed. Removing the lamina increases the size of the spinal canal to relieve pressure.

Foraminotomy or foraminectomy: Both of these procedures are done to expand nerve root endings that exit the spinal cord by removing some bone and tissue. A foraminectomy involves removing large amounts of bone and tissue.

Osteophyte removal: This procedure involves the removal of bone spurs.

Coping 

You can try some home remedies to help manage pain and inflammation, including heating pads, ice packs, massage, and warm showers.

Additional things you can do to make it easier to cope with the pain and inflammation from spinal cord compression include:

• Practice deep breathing and meditation. Both activities can help your body to relax, which may ease pain.
• Reduce stress. Stress can intensify inflammation and pain.
• Exercise. Moving is important to managing pain effectively. Talk to your healthcare provider about what exercises are safe to do while living with spinal cord compression.
• Don’t smoke. Smoking makes pain worse by causing circulation problems that lead to more pain.
• Cut back on alcohol. Alcohol contributes to sleep problems, and lack of sleep makes pain worse.
• Distract yourself. Find ways to distract yourself from the pain so you can enjoy life more. Any activity that keeps you busy and thinking about things besides pain can help. You may not be able to avoid pain, but you will at least feel like you have some control over your life.
• Find the right mattress. Changing your mattress can help ease some of your spine pain. Look for a mattress that is not too firm or too soft. The right mattress should help you to get a better night’s sleep and ease some of your neck and/or back pain.

A Word From Verywell 

Many of the causes of spinal cord compression cannot be prevented. You can prevent injury by keeping your back healthy and reduce pain by maintaining a healthy weight and getting regular exercise. Regular exercise strengthens the muscles that support the back and helps to keep the spine flexible. Keeping a healthy weight is important because excess weight can put stress on your back and increase the chance of developing spinal cord compression.

Practice good body mechanics when standing, lifting, and sitting. Body mechanics refers to the way we move our bodies during daily activities. Use of proper body mechanics can help you to avoid injury and muscle fatigue. It is also a good idea to maintain good posture. Other body mechanics practices include sleeping on a firm mattress or sitting in a chair that supports posture.