How effective is palliative radiotherapy for spinal cord compression?

Spinal cord compression occurs when cancer in or near the spine presses on the spinal cord or its nerves. This can cause back pain, weakness, altered sensation and problems walking or controlling urine or bowel movements. Radiotherapy can target the responsible tumour and reduce pressure over time. The team may first use steroids, pain relief, scans and measures to keep the spine stable. Surgery may be considered when the spine is unstable, the compression needs mechanical relief, or the person is suitable for an operation. The likely benefit depends on nerve function before treatment, the compression site, tumour features and how quickly treatment begins.

Treat suspected spinal cord compression as an emergency. Contact the oncology service immediately or go to an emergency department if new back pain is accompanied by weakness, numbness, unsteady walking or bladder or bowel changes. Keep still and avoid lifting, twisting or walking unsupported until a clinician advises you. Tell the team about prior cancer, current medicines and when each symptom began. During planning, ask how radiotherapy fits with steroids, surgery, systemic treatment and rehabilitation. Read about [Palliative Radiotherapy](/treatments/radiation-oncology/palliative-radiotherapy/).

Seek emergency care immediately for new or worsening limb weakness, numbness that spreads, difficulty standing or walking, severe unrelenting back pain, or loss of bladder or bowel control. Do not wait to see whether rest or a painkiller settles these symptoms. Sudden paralysis, collapse or severe breathing difficulty requires emergency services. Early assessment may allow treatment to protect remaining nerve function.

Where is the compression, and is the spine stable? Do I need steroids, surgery or immobilisation before radiotherapy? What nerve function are we trying to preserve? How soon can treatment start? Which changes should lead me back to emergency care, and what rehabilitation will I need afterward?