Clinical Presentation

• Back pain and red flag features (e.g. cancer)
• New weakness or change in sensation (especially if they have a sensory level on exam)
• Bowel/bladder dysfunction: can be urinary retention and fecal constipation or urinary or fecal incontinence

Prognosis is very poor for patients with complete paralysis for > 24 hours. Prognosis is best for patients with new, incomplete paralysis.

Evaluation

• Exam: thorough motor and sensory exam, rectal tone
• Imaging: emergent MRI
  • If there is concern for metastatic cancer causing cord compression, get MRI of cervical, thoracic, and lumbar spine (note that 60-70% of metastatic cancer causing cord compression occurs in the thoracic spine)

Treatment

• This is a surgical emergency—call neurosurgery early; if uncertain about your exam, consult neurology
• Stabilize the spine: cervical collars for C-spine compression
• Dexamethasone is only indicated for metastatic cord compression (10 mg load and then 6 mg q 4 hours or 4 mg q 6 hours)
• If tumor, consult radiation oncology