Spinal cord and nerve root compression
Localising cord, conus, cauda equina and root lesions, malignant cord compression (MRI whole spine within 24 hours, dexamethasone, SINS, surgery and radiotherapy), epidural abscess, degenerative cervical myelopathy, and radiculopathy where imaging, opioids and pregabalin add little.
Tier 1Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Compression of the cord or cauda equina is an emergency. Function at the start of treatment predicts function at the end.
- Localise first: cord (upper motor neuron signs below a sensory level), conus (mixed signs, early sphincter loss), cauda equina (lower motor neuron, saddle anaesthesia, bladder) or root (dermatomal pain, myotomal weakness, one reflex).
- Malignant cord compression is often the first sign of cancer. New back pain in a person with cancer needs an MRI plan.
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Sources
- Spinal metastases and metastatic spinal cord compression (NG234)NICE, 2023
- eviQ: malignant spinal cord compression (oncological emergencies)AU/NZCancer Institute NSW
- Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trialPatchell RA et al., Lancet 2005;366(9486):643-648, 2005
- Effect of single-fraction vs multifraction radiotherapy on ambulatory status among patients with spinal canal compression from metastatic cancer: the SCORAD randomized clinical trialHoskin PJ et al., JAMA 2019;322(21):2084-2094, 2019
- A novel classification system for spinal instability in neoplastic disease (SINS)Fisher CG et al., Spine 2010;35(22):E1221-E1229, 2010
- A clinical practice guideline for the management of patients with degenerative cervical myelopathyFehlings MG et al. (AO Spine), Global Spine Journal 2017;7(3 Suppl):70S-83S, 2017
- Low Back Pain Clinical Care StandardAU/NZAustralian Commission on Safety and Quality in Health Care, 2022
- Trial of pregabalin for acute and chronic sciatica (PRECISE)AU/NZMathieson S et al., New England Journal of Medicine 2017;376:1111-1120, 2017
- Opioid analgesia for acute low back pain and neck pain (OPAL)AU/NZJones CMP et al., Lancet 2023;402(10398):304-312, 2023
- Therapeutic Guidelines: Neurology; Antibiotic (spinal epidural abscess)AU/NZTherapeutic Guidelines Limited
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy