Figure 1: MRI of the spine (saggital section) showing pathological fracture dislocation of Thoracic vertebra T5 posteriorly and compressing on the spinal cord (Click on picture to enlarge)

Figure 2: MRI of the spine (transverse section) showing tumour (thyroid carcinoma metastasis - white arrow) invading and destroying the T5 vertebral body with compression of the spinal cord (Click on picture to enlarge)  



Spinal cord compression is a medical emergency and occurs as a result of compression of the spinal cord (Figure 1 white arrow
) by bone fragments from a vertebral fracture, ruptured vertebral disc, an abscess, a tumour or metastases (Figures 1 and 2). Symptoms suggestive of spinal cord compression include an acute onset of back pain, dermatone of increased sensation, paralysis below the level of compression, urinary and fecal incontinence or retention. Lhermitte’s sign (intermittent shooting pain) and hyperreflexia may be present.


Urgent radiological investigations are required usually with MRI as shown above of the whole spine (Figure 1
). The most common causes of cord compression are tumours such as lung cancer (non-small cell lung cancer), breast cancer, prostate cancer, renal cell carcinoma, thyroid carcinoma, lymphoma and multiple myeloma. Infective causes include abscesses and granulomas such as tuberculosis. The case above was due to a thyroid carcinoma bony metastasis to vertebral body T5 resulting in destruction of the body of the vertebra and subsequent posterior dislocation of T5, resulting in compression of the spinal cord.


Once diagnosis is confirmed, dexamethasone is given intravenously to reduce the peri-lesion oedema and hence relieved the compressive pressure off the cord.
Emergency radiotherapy (20Gy/5fractions, 30Gy/10fractions, or 8Gy/1fraction) is the mainstay of treatment for malignant spinal cord compression in centres where radiotherapy is available. If this is not available, then decompressive surgery is the main stay of therapy in order to prevent permanent neurological damage to the cord and permanent paralysis. Surgery is also indicated if permanent paralysis has occurred for pain controlled. Post-operative radiation is delivered within 2-3 weeks of surgical decompression as adjuvant therapy for the tumour.


The median survival of patients with metastatic spinal cord compression is about 12 weeks, due to the advanced nature of the underlying malignant disease.


Image contributed and prepared by

Dr Ian Bickle, Department of Radiology,

Text prepared by

Mr William Chong, Department of Surgery,

RIPAS Hospital, Brunei Darussalam.

All images are copyrighted and property of RIPAS Hospital.