Find out about treatments for pressure on the spinal cord (spinal cord compression).
Treatment for spinal cord compression should start as soon as possible, usually within 24 hours of diagnosis. This reduces the chance of permanent damage to the spinal cord.
Treatment can also control symptoms of compression. Some people have pain. Other people have nerve symptoms, such as numbness or tingling.
Your doctor will talk to you about your options. Treatment aims to get you back to normal as much as possible and as soon as possible.
Planning your treatment
There are a number of different treatments. 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
Steroids are drugs that help reduce swelling and relieve pressure on the spinal cord. They are normally the first treatment you have.
Dexamethasone is a steroid. You have it as a tablet or as a drip into a vein in your arm. You normally start having a high dose and your doctor reduces your dose as your symptoms improve. The dose reduces slowly over a few weeks if you have radiotherapy or surgery.
You should take your steroids exactly as your doctor or nurse has told you.
You might need to lie flat for some time to reduce movement in your spine and prevent any more damage to your spinal cord.
Your physiotherapists will help you sit up carefully and give you ways to move around, once it is safe to do so. They might give you a collar or brace to wear to protect your spine.
Pain is the main symptom of spinal cord compression. You can have painkillers to control it. You might need to try a few different types or strengths until your pain is under control.
Let your nurse know if you still have pain, for example when you move or open your bowels. They can give you extra painkillers or ‘top-ups’ at these times.
Other treatments to reduce the pressure on the spinal cord can also help to control any pain.
Radiotherapy reduces pressure on the spinal cord by targeting and destroying the cancer cells. This reduces pain and other symptoms.
You might have 1 dose of radiotherapy to help with the pain when you are first diagnosed. Or you might have a number of treatments over 5 to 10 days.
Surgery can help to relieve pressure on your spinal cord and strengthen the spine. It involves having a general anaesthetic. Your surgeon will try to remove the tumour and any bone that is pressing on the spinal cord. Or you might have steel rods put into your spine to strengthen it.
You might have radiotherapy after surgery.
People with myeloma or breast cancer might have bisphosphonates (pronounced bis-fos-fon-ates) to help control pain and strengthen the bones in the spine. If you have prostate cancer, you might have medicines called bisphosphonates if painkillers are not working well enough.
Denosumab is a type of biological therapy called a monoclonal antibody. It helps strengthen the bones and reduces the risk of them breaking. You have it as an injection under the skin.
The National Institute of Health and Care Excellence (NICE) has approved denosumab for breast cancer that has spread to the bone. They have also approved it for people with some other types of cancer.
NICE hasn’t recommended denosumab for men with prostate cancer. This is because there is not enough evidence it is better than other treatments.
Injecting bone cement into the spine
You might have this treatment if painkillers aren’t controlling your pain. Or you might have it if the bones of the spine have collapsed.
Vertebroplasty or kyphoplasty are two ways of injecting special medical cement into the spine.
With a vertebroplasty your doctor injects the medical cement into the area where the swelling is pressing on the spinal cord.
Kyphoplasty is similar, but your doctor uses a balloon through a needle to help create the normal shape of the bone.
You might have chemotherapy treatment for spinal cord compression. This is most likely if you have lymphoma, germ cell cancer or small cell lung cancer.
Having spinal cord compression means you are more likely to develop other health problems. These happen because you aren’t able to move about as normal.
Lying still increases your risk of blood clots. Wearing elastic compression stockings helps to lower your risk. You might also have an anticoagulant (blood thinning) medicine. You have this as a tablet or an injection under the skin.
Lying down in bed can increase your risk of a chest infection. A physiotherapist can teach you deep breathing exercises. This helps to reduce your chance of getting a chest infection.
When you are ready, your nurses will help you sit up. It’s important to sit up and out in a chair if it is safe to do so. Sitting up helps you breathe more deeply and reduces your risk of infections.
To prevent pressure sores you need to change position regularly. Your nurse will show you how and will help you if you can’t move much.
You might have a pressure relieving mattress or cushion for when you sit up.
Bladder and bowel problems
Pressure on your nerves might make it difficult for you to control your bladder or bowels. You may need a tube called a catheter to drain the bladder. You might also need medicines to help your bowel work.
Your doctors and nurses will start planning for when you go home while you are in hospital. This includes referring you for district nursing support.
Physiotherapists and occupational therapists should also work out a plan with you and your family. They aim to make sure you can live as independently as possible if you still have problems moving around. They can arrange equipment, such as a wheelchair, or changes to your home, such as grab rails.
Your local social services may also provide equipment or any care or help you need.
Research and clinical trials
Research is looking into spinal cord compression. This includes research into treatments such as drugs, radiotherapy and surgery.
The SCORAD 3 trial compared a single radiotherapy treatment and a course of radiotherapy treatment for people with spinal cord compression. Researchers are now looking at whether the single treatment worked as well as the course.
The PROMTS trial is looking at using magnetic resonance imaging (MRI scans) to pick up early signs that prostate cancer is starting to cause pressure on the spine.