Assessment of spinal cord compression

Among the various skeletal complications, early detection and assessment of vertebral compression fractures with the risk of, or resulting in, spinal cord compression is the most important.

Spinal cord compression is considered a medical emergency. Any of the following neurological symptoms indicate possible spinal cord compression and immediate attention is necessary to prevent permanent damage:

• Severe back pain
• Radiculopathy – causing numbness, tingling, shooting pains
• Any limb weakness or difficulty in walking
• Loss of sensation
• Loss of bladder or bowel control

Although back pain is a common symptom in myeloma, particular attention should be paid if patients report the following as these are characteristic of spinal cord compression:

• Pain in cervical or thoracic spinal regions
• Progressive pain in the lumbar region
• Severe unremitting lower spinal pain
• Spinal pain aggravated by straining (e.g. when opening bowel) or when coughing or sneezing
• Localised spinal tenderness
• Pain when lying down

Confirmation of spinal cord compression requires a whole-body or spinal MRI scan together with a functional assessment. This assessment is normally carried out by a haematologist, oncologist or neurologist.

Further reading

Kaiser et al. (2024) Advanced imaging for earlier diagnosis and morbidity prevention in multiple myeloma: A British Society of Haematology and UK Myeloma Society Good Practice Paper. Br J Haematol. 2024;205:1319–1325.

Hillengass et al. (2019) International myeloma working group consensus recommendations on imaging in monoclonal plasma cell disorders. Lanc. Oncol. doi.org/10.1016/S1470-2045(19)30309-2

Chantry et al. (2017) Guidelines for the use of imaging in the management of patients with myeloma. B J Haem. https://doi.org/10.1111/bjh.14827