Spinal Cord Compression: An Obstructive Oncologic Emergency

Maryjo Osowski, RN, MSN, AOCN


Topics in Advanced Practice Nursing eJournal. 2002;2(4) 

In This Article

Clinical Presentation

The presenting signs and symptoms depend on the location and level of the metastatic tumor.[5] (See Table 1 .) The thoracic spine is the site most often involved (70% of cases), followed by the lumbosacral spine (20%) and the cervical spine (10%).[9] Other variables include the degree of cord impingement and the duration of tumor involvement.[3] The cardinal initial symptom of SCC is back pain, reported by 90% to 95% of patients. The pain can be localized, radicular, or both and usually precedes other symptoms by 2-4 months.[3]

Local pain occurs over the area of the tumor and is caused by vertebral destruction or stretching of the bone by an enlarging tumor mass. Radicular pain is caused by compression of nerve roots and is found in the dermatomes affected by the nerve roots.[6] Radicular pain may travel down the extremity associated with the area of compression and may be aggravated by the Valsalva maneuver.[7,8] Often the pain is described as a soreness or vague discomfort, which progresses to more severe symptoms such as weakness in one or both limbs, loss of sensation, and then autonomic dysfunction and paralysis.[2,3] This pain often begins as a nonspecific soreness, which could be attributed to any number of other conditions, such as arthritis, muscle strain, or old injury to the vertebrae.