Acute spinal cord compression: urgent signs and care

New or worsening back or neck pain together with leg or arm weakness, numbness, difficulty walking, or changes in bladder or bowel control needs immediate assessment. In a person with cancer, these features may indicate malignant spinal cord compression even if the cancer has been stable.

The spinal cord carries signals between the brain and the body through the spinal canal. A tumour in or near the spine, collapse of a weakened vertebra, swelling, bleeding or infection can narrow that space. Multiple myeloma and other cancers that involve bone can weaken vertebrae or form tissue that presses on neural structures.

Pain may feel severe, band-like or worse with coughing, straining, movement or lying down. Nerve irritation can send pain around the chest or abdomen or down a limb. Weakness, altered sensation and balance trouble indicate that nerve function may already be affected; waiting for paralysis can allow avoidable injury to progress.

Call emergency services or go to an emergency department if warning signs are present. Tell the team about any current or previous cancer and the exact time symptoms began. Avoid driving yourself if weakness, numbness or poor balance could make travel unsafe, and limit unnecessary bending or lifting until the spine has been assessed.

Clinicians check limb strength, sensation and reflexes, then usually arrange urgent imaging of the spine. Medicines may be given to reduce swelling when tumour-related compression is suspected. Depending on the cause, spinal stability, overall health and cancer plan, treatment may include palliative radiotherapy, tumour removal surgery or another procedure to relieve pressure and stabilise the spine.

Get emergency help now for new leg or arm weakness, inability to stand, spreading numbness, numbness around the buttocks or genitals, loss of bladder or bowel control, inability to pass urine, or rapidly worsening back or neck pain with neurological symptoms. Sudden symptoms after a fall or injury also need immediate evaluation.

Ask what is causing the pressure, which spinal levels are involved, whether the spine is stable, how quickly treatment will begin, what movement is safe, how pain will be controlled, and whether rehabilitation can help preserve or recover mobility and daily function.