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Treating spinal cord compression

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This page has information about treatment for spinal cord compression. There is information about

 

How your doctor decides about treatment

As well as treatment for the spinal cord compression, you will have treatment to manage your symptoms. The type of treatment you have depends on your symptoms. Treatment for spinal cord compression usually includes one or more of the following

Treatment should start as soon as possible. This is to reduce the chance of permanent damage to the spinal cord. When planning your treatment your doctor will consider

  • Your general health and fitness
  • What you are able to do
  • Any treatment you have already had
  • The possible side effects of treatment
  • The stage of your cancer
  • The part of your spine affected
  • Your wishes and needs

The aim of treatment depends on your symptoms. Some people have pain. Other people have nerve symptoms, such as numbness or tingling, or difficulty walking. Your doctor will talk to you about what the treatment aims to do. 

Treatment aims to get you back to normal as far as possible and as soon as possible. Unfortunately treatment may not always be able to help some people walk again.

 

Steroids

Steroids are drugs that help to reduce swelling and can help to relieve pressure on the spinal cord. They are usually the first treatment your doctor recommends. You may have steroids to reduce swelling before radiotherapy or surgery. 

You usually start with high doses of dexamethasone. Once your symptoms improve, or after surgery or radiotherapy, your doctor will slowly reduce your steroid dose until you can stop taking it. We have more information about steroids

 

Lying flat

You may need to lie flat for a while to reduce the movement of your spine and protect your spinal cord from damage. Once your doctor thinks that there is no risk from movement, physiotherapists will help you to sit up and then gradually move around. They may give you a collar or brace to help protect your spine.

 

Pain control

One of the main symptoms of spinal cord compression is back pain. Your doctor will prescribe painkillers to help control any pain.

As well as painkillers you may have

Your doctor may also refer you to a specialist pain control team. There is information about managing pain in the section on coping physically with cancer.

 

Radiotherapy

Doctors usually treat spinal cord compression with radiotherapy. You start this as soon as possible after being diagnosed. Radiotherapy destroys cancer cells, which can help to reduce the pressure on the spinal cord. You may have a single radiotherapy treatment to help reduce pain when you are first diagnosed. Or you may have a number of treatments over a few days or weeks.

At the moment doctors are not sure how many radiotherapy doses (fractions) it is best to give. It can depend on local practice, your overall condition and how much radiotherapy they think you are able to cope with. The SCORAD 3 trial is comparing a single radiotherapy treatment with a course of radiotherapy for spinal cord compression. The aim of the trial is to compare the treatments to see how well they work. And to find out more about the side effects of these treatments. 

If you've had surgery to relieve pressure on your spinal cord you may have radiotherapy afterwards, once your wound has healed.

We have more information about radiotherapy for spinal cord compression.

 

Surgery

Surgery can help to relieve pressure on your spinal cord and strengthen the spine. It involves having a general anaesthetic. You may have surgery as well as radiotherapy and steroids.

If a tumour is causing pressure on the spine, your surgeon will try to remove the tumour and any bone that is pressing on the spinal cord. They will use a special cement to fill any gaps.

To stabilise or strengthen the spine, your doctor may put steel rods into your spine.

Surgery isn’t suitable for everyone. But it can help to control pain and may mean that you can still move around.

 

Bisphosphonates

If you have myeloma, breast cancer or prostate cancer you may have bisphosphonates (pronounced bis-fos-fon-ates) to help to control pain and strengthen the bones in your spine. It is not known how well bisphosphonates work for other types of cancer. So in this case you may have bisphosphonates as part of a clinical trial.

We have more information about bisphosphonates.

 

Biological therapy

Denosumab is a type of biological therapy called a monoclonal antibody. It helps strengthen bones and reduces the risk of a break (fracture). You have it as an injection under the skin.

The National Institute of Health and Care Excellence (NICE) has approved denosumab as a treatment for bone secondaries from breast cancer and from other types of cancer that would otherwise have bisphosphonates. But they have not approved denosumab as a treatment for prostate cancer that has spread to the bone because there is not enough evidence that it is better than other treatments.

 

Injecting bone cement into the spine

There are 2 ways of injecting special medical cement into the spine. They are called vertebroplasty and kyphoplasty. The NICE guidelines on metastatic spinal cord compression recommend vertebroplasty or kyphoplasty if you have pain that is not controlled by painkillers, or if the bones of the spine have collapsed.

Vertebroplasty is when your doctor injects a special cement mixture into the area where the spine is pressing on the spinal cord. This lifts the spine off the cord and relieves the symptoms.

Kyphoplasty is similar to vertebroplasty but your doctor inserts a small balloon through a needle to help to create the normal shape of the bone. The doctor then removes the balloon and injects cement into the space it has made.

Doctors use X-rays to guide both of these procedures.

 

Chemotherapy

Sometimes doctors give chemotherapy as the first treatment for spinal cord compression. This is most likely if you have lymphoma or small cell lung cancer.

 

Other problems you may have

If you have spinal cord compression you are more likely to develop other health problems. These are mostly caused by not being able to move around as much as normal. They include

  • Blood clots
  • Chest or breathing problems
  • Pressure sores
  • Bowel and bladder problems

To lower the risk of blood clots you may need to wear elastic compression stockings and take medicine to thin your blood. This type of medicine is called an anticoagulant. You may also see a physiotherapist to help with deep breathing exercises. This is because lack of movement can increase your risk of chest infection.

If you are at risk of pressure sores your nurse will show you how to change position regularly and will help you if necessary. You may need a pressure relieving mattress or a special cushion to sit on.

If pressure on nerves is making it difficult for you to control your bladder or bowel, you may need a tube called a catheter to drain the bladder and drugs to help your bowel work.

 

Going home

As well as giving treatments to control pain and reduce the pressure on your spinal cord your doctors and nurses will plan for you to go home.

If you have symptoms that make it hard for you to move around you may not be able to get totally back to normal. So you may need help to live as independently as possible. You will see a physiotherapist and occupational therapist. They will work out a plan with you and your family to get you home and work out exactly what you will need. For example, you may need a wheelchair or changes made to your home. It is important that your team plan ahead so that going home is as easy as possible for you.

Your local social services may also be involved in getting equipment for your home. They may also be able to provide help if you need it. Your hospital team may refer you to your local community nursing team for support.

Once your treatment has finished you will have regular check ups. Remember to contact your doctor or specialist nurse straight away if you have any new symptoms. You don’t have to wait for your next appointment.

 

Your feelings

It can be difficult to cope with changes caused by spinal cord compression. It is not unusual to feel frightened, angry and upset. Everyone reacts differently. It is important to give yourself time to get used to the changes and to get the support that you need. Do ask for help. There is a lot of support if you need it. Your doctors or nurses will be able to put you in touch with people specially trained in supporting people with cancer.

Getting information about your condition can also be very helpful. People who are well informed about their illness and treatment tend to be more able to make decisions and cope with what happens.

You can also find details of counselling organisations, that can tell you about counselling and help you find sources of emotional support in your area. If you want to find people to share experiences with online, you could use CancerChat, our online forum. 

There is more information in the coping with cancer section, including information about dealing with your emotions.

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Updated: 24 November 2014