30th December 2024

Presentation of MSCC

Pain

Back pain may precede neurological symptoms and may be constant and severe. This may be acute or subacute. In patients with known bony metastases with back pain, any sudden change in back pain should prompt investigation.

Neurological symptoms

The patient may notice any degree of weakness, sensory loss or paraesthesia in their arms (if cervical lesion) or legs (if lesion is thoracic or lower). They may describe new faecal incontinence with or without saddle anaesthesia. They may also have symptoms of urinary retention – difficulty passing urine, suprapubic pain, dribbling and overflow incontinence. These neurological symptoms are usually late signs of cord compromise.

Examination findings

In all patients presenting with suspected MSCC, it is essential to perform a full neurological examination, including a bladder scan to assess for urinary retention and a digital rectal examination to assess anal tone. Regular neurological examinations should be performed thereafter to monitor for any neurological deterioration.

On examination, there may be point tenderness on palpation of a vertebra overlying the compressive lesion.

There may be a pattern of complete or incomplete spinal cord neurological compromise. If complete, there will be a sensory level just below the level of compression, and below this there will be complete sensory loss and an upper motor neuron pattern of weakness. This would also be accompanied by bowel and bladder dysfunction.

The spinal cord ends at L1-2, and lesions below this may compress the cauda equina. This would characteristically result in sciatic pain, sexual dysfunction, urinary retention, saddle anaesthesia and loss of anal tone.