Compression of the spinal cord occurs in up to 5% of patients with cancer. The main problem in clinical practice is failure of recognition. It is not uncommon for a patient's weak legs to be attributed to general debility and urinary and bowel symptoms to be attributed to medication. Neurological symptoms and signs can vary from subtle to gross, from upper motor neurone
Presentation of spinal cord compression can be subtle in the early stages. Any patient with back pain and subtle neurological symptoms or signs should have radiological investigations, with magnetic resonance imaging when possible to lower motor neurone, and from minor sensory changes to clearly demarcated sensory loss.
Prompt treatment is essential if function is to be maintained: neurological status at the start of treatment is the most important factor to influence outcome. If treatment is started within 24-48 hours of onset of symptoms neurological damage may be reversible.
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