Pathophysiology

• Usually a complication of cancer.
• Can occur as a result of soft tissue expansion or sudden vertebral collapse.
• In children, onset often insidious.
• Classically sudden onset of back pain, but see below.
• Neurological symptoms, particularly loss of bladder or bowel control.
• Unexplained lack of mobility.
• In children, onset is typically more insidious than in adults and classic symptoms and signs may not appear.

Management

• Depends on situation.
• Urgent reduction of tumour oedema with high dose Dexamethasone.
• Reduction of tumour mass through radiation or emergency debulking surgery.
• Outcome for neurological recovery is poor if symptoms have been present for more than 48 hours.
• In practice, cord compression in children is typically non acute, and it is common for there to be no neurological recovery in the palliative situation.