Definition

Acute spinal cord compression is a condition caused by pressure or compression on arteries, veins, or cavities around the spinal cord, called the spinal cord. Acute spinal cord compression is a dangerous condition that can occur in almost all age groups and has a high morbidity. Depending on the location of the compression point, the impacts affecting the body will vary.

Causes

Pressure or compression on the spinal cord can be caused by many things, ranging from spinal fractures, and infections, to spreading cancer. In acute spinal cord compression, this pressure occurs suddenly and causes more severe symptoms.

 The central nervous system (CNS) consists of two organs, namely the brain and the spinal cord or spinal cord. The spinal cord is a bundle of nerves protected by the spine. These nerves originate from the head area and end at the pelvis, then branch out to various areas of the body. These nerves function to convey messages from the brain to the entire body to regulate movement, sensation, and autonomic functions (involuntary or unconscious bodily functions). The spinal cord is divided into three main areas: the neck region (cervical), the chest region (thoracic), and the pelvic region (lumbar).

 If something compresses the spinal cord, whether due to trauma or non-trauma, the function of regulating sensation, movement, and autonomic body activities will be disrupted. Functional disturbances will be greatly influenced by the location of the damage. Damage occurring in the chest (thoracic) and pelvic (lumbar) regions will affect the chest area, legs, abdomen, bladder control, and sexual function; whereas damage to the neck region (cervical) will affect the neck area, hand movements, and in more severe conditions, may interfere with breathing.

 Things that can cause compression or pressure on the spinal cord include:

• Trauma - Traffic accidents, falls, violence and sports accidents can cause spinal fractures and compression of the spinal cord.
• Malignancy - Malignancies generally occur in the thoracic (60%), lumbosacral (30%), and cervical (10%) regions. About 85% of spinal cord malignancies originate from cancer that begins in other organs or results from metastasis. The tumor will grow around the spinal cord and as it grows, will compress the spinal cord, its branching nerves, and blood vessels. This can lead to tissue death.
• Infection - Infections that often cause compression of the spinal cord are discitis, tuberculosis (Pott's disease), and epidural abscesses. Infections that occur around the spinal cord can form abscesses and compress the spinal cord. These infections are caused by bacteria such as Streptococcus, Pseudomonas, E. coli, and Mycobacterium tuberculosis.
• Hemorrhage - A collection of blood (hematoma) around the spinal cord can cause compression of the spinal cord.

Risk factor

Factors that can increase the risk of acute spinal cord compression include: 

• Male - Accidents are more common in males. In the United States, only 20% of cases of spinal cord compression due to accidents are experienced by females.
• Age 16–30 years
• Age over 65 years - Increased incidence of acute spinal cord compression occurs in the elderly, due to the high incidence of falls.
• History of malignancy - Breast, prostate, kidney, and lung malignancies have a risk of metastasis, thus causing acute compression.
• Osteoporosis - This disease can increase the risk of fractures or broken bones that potentially compress the spinal cord.
• Intravenous drug use
• Immunosuppression

Symptoms

The symptoms that can be experienced will depend on the location of the spinal cord compression. Possible symptoms include:

 Pain triggered by movement in the back area

• Sudden inability to move legs or arms (paralysis)
• Sudden loss or decrease in sensation of touch, heat, cold, and touch
• Inability to control urination (incontinence)
• Decreased sexual function

In more severe conditions, sudden paralysis may occur accompanied by difficulty breathing, coughing, or coughing up phlegm from the throat

• Fever, back pain, and sudden weakness with a history of infection may be caused by an epidural abscess
• Significant weight loss in a short period

Danger signs of spinal cord disruption after trauma or accident include:

•  Severe pain in the back, neck, or head
• Weakness in hands, legs, or entire body
• Numbness or tingling sensation
• Inability to control urination or defecation
• Inability to walk, body position imbalance, and weak legs
• Difficulty breathing

Diagnosis

Diagnosis can be established clinically. Your doctor will inquire about your medical history and related symptoms, previous illnesses, trauma history, and treatment history.

 Common diagnostic tests include MRI scans. With an MRI, your doctor can see the condition of your spinal cord in more detail. Other imaging that can be used is a CT scan, if needed urgently or MRI is not available. Other tests that may be performed if there is a suspected infection include complete blood tests and blood cultures. Lumbar puncture examination is rarely the primary choice of examination.

Management

The goal of managing acute spinal cord compression is to relieve pressure on the spinal cord. This can be done through surgery or medication, depending on the underlying cause of the disease and the current condition.

•  For compression caused by malignancy, your doctor may prescribe anti-inflammatory drugs for 10 days to reduce inflammation
• For compression caused by infection, your doctor will clean the abscess or infection mass through surgery. Surgical therapy methods are said to be more effective compared to antibiotic therapy alone
• Treatment with antibiotics alone can be done if no serious conditions are found in patients, such as paralysis symptoms and loss of nerve sensation

Complications

Acute spinal cord compression can cause total paralysis, permanent nerve damage, and other diseases caused by lying down for a long time, such as pressure ulcers, DVT (Deep Vein Thrombosis), pulmonary embolism, and urinary tract infections. Surgical complications in acute spinal cord compression due to malignancy occur in about 25%, while complications that can occur after surgery for epidural abscesses include changes in the shape of the spine to be more hunched (kyphosis) and continuous nerve disturbances.

Total paralysis is found in 4–22% of patients with acute spinal cord compression, especially if paralysis occurs more than 24 hours before surgery. About 5% of people with epidural abscesses die from sepsis (complications of infection causing organ system disorders).

Prevention

Some things below can reduce the risk of acute spinal cord compression, including:

• Be cautious when driving. Accidents are the leading cause of spinal cord disorders. Drive carefully and use a seat belt when driving
• Avoid falls. Ensure that your home floor is not slippery, if there are elderly people who are prone to falling at home, you can install grip bars or wall handles at home or in the bathroom.
• Monitor your health condition by consuming medications according to the advice and instructions from healthcare professionals, especially if you have chronic infections such as tuberculosis and malignancy conditions.

When to see a doctor?

If you have an accident or fall and experience sudden back pain, especially if you have a history of infection or cancer, it's crucial to seek immediate medical attention at the nearest healthcare facility. The time between the onset of symptoms and medical intervention greatly affects patients' recovery.

 If you encounter someone suspected of experiencing spinal cord trauma, follow these steps: 

• Do not move the person until healthcare personnel arrive.
• Seek immediate assistance.
• Ensure the neck remains in its original position.
• Provide first aid without moving the neck or head.

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