Pain, characteristically with a nerve root or 'girdle' distribution, exacerbated by coughing or straining and not relieved by bed rest frequently precedes neurological symptoms or signs. Any patient with cancer who develops severe back pain with a root distribution should be considered at risk of spinal cord compression and urgently investigated.

Weakness of the legs (and arms if the lesion is high in the spine), retention, dribbling, or incontinence of urine or faeces, and constipation, may occur and are late symptoms.

Cauda equina syndrome

The spinal cord ends at the level of L1 or L2. Tumours below this level may produce cauda equina compression with sciatic pain (often bilateral), bladder dysfunction with retention and overflow incontinence, impotence, sacral (saddle) anaesthesia, loss of anal sphincter tone, and weakness and wasting of the gluteal muscles. The symptoms may be unclear and the diagnosis difficult to make without MRI.

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