Treatment for 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

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

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 your bloodstream (intravenous). You normally start having a high amount (dose) and your doctor lowers your dose as your symptoms improve. The dose reduces slowly over a few weeks if you have radiotherapy or surgery.

You take your steroids exactly as your doctor, nurse or pharmacist tells you. You should take the right dose, not more or less. Never stop taking the steroids without talking to your doctor first.

Lying flat

You might need to lie flat for some time to reduce movement in your spine and prevent any more damage to your spinal cord.

You'll see a physiotherapist who 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.

Painkillers

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 or doctor know if you still have pain, for example when you move or go to the toilet. They can give you extra painkillers or ‘top-ups’ at these times.

You might have other treatments such as steroids to reduce the pressure on the spinal cord, as it can also help to control any pain.

Radiotherapy

Radiotherapy means using high energy x-rays to target and destroy cancer cells. By relieving pressure on the spinal cord it can help reduce pain and improve other symptoms.

Depending on your situation you might have other treatments with radiotherapy including:

• painkillers
• steroids
• surgery

Each radiotherapy treatment is called a fraction and takes a few minutes. You might have one dose of radiotherapy to help with the pain. Or you might have a number of treatments over 5 to 10 days.

The number of fractions you need depends on your general health and other treatments you are having, such as surgery.

Your doctor will tell you how many fractions you need.

Surgery

Surgery can help to relieve pressure on your spinal cord and strengthen the spine. It involves having a general anaesthetic, so you're asleep for the operation. 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.

Your doctor will explain in detail the surgery and the possible risks after surgery.

Bisphosphonates

Bisphosphonates (pronounced bis-fos-fon-ates) are drugs that help prevent or slow down bone thinning (osteoporosis). They can help to treat some types of cancer that cause bone problems and help reduce pain.

People with myeloma or breast cancer might have bisphosphonates to help control pain and strengthen the bones in the spine. If you have prostate cancer, you might have bisphosphonates if painkillers are not working well enough.

Targeted cancer drugs

Denosumab is a type of targeted cancer drug 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.

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.

Chemotherapy

You might have chemotherapy for spinal cord compression. This is most likely if you have lymphoma, germ cell cancer or small cell lung cancer.

Chemotherapy drugs work by killing cells that are in the process of splitting into two. Cancer cells divide much more often than most normal cells, so chemotherapy is much more likely to kill them.

Chemotherapy drugs circulate throughout your body. So it can treat cancer cells almost anywhere in the body.  

Hormone therapy

Hormone therapy works by blocking or lowering the amount of hormones in the body to stop or slow down the growth of cancer. You might have hormone therapy to treat cancer that has spread to the spine. For example, if you have prostate cancer that has spread to the spine you might have the hormone therapy drug Degarelix.

Other problems

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.

Blood clots

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.

Chest problems

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.

Pressure sores

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.

Going home

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

In the UK, researchers are looking to see if using magnetic resonance imaging (MRI scans) can pick up early signs that prostate cancer is starting to cause pressure on the spine (PROMPTS trial). 

There is also other research into spinal cord compression that is happening around the world. These studies are looking at:

• different types of radiotherapy
• radiotherapy given at different strengths
• having radiotherapy with a chemotherapy drug called nab-paclitaxel
• using heat therapy (thermal ablation) with a type of radiotherapy called stereotactic radiotherapy (SBRT)