Spinal Cord Compression

Key points

• Oncological emergency affecting up to 5% of cancer patients; mostly extradural (vertebral metastases) — lung, breast, prostate.
• Earliest/commonest symptom: back pain (worse lying down/coughing) → limb weakness, sensory loss.
• Above L1: UMN signs + sensory level; below L1: LMN signs + perianal numbness; reflexes increased below, absent at the lesion.
• Management: high-dose oral dexamethasone + urgent oncology for radiotherapy or surgery.