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Spinal cord compression in myeloma: the signs and what to do | CION Cancer Clinics
In myeloma, new or worsening back pain with weak or numb legs, unsteady walking, or new bladder or bowel trouble can mean the spinal cord is being squeezed. Go to the nearest emergency department today or call 108. Treatment within hours, with steroids, an urgent MRI and radiotherapy or surgery, gives the strongest chance of keeping the ability to walk. This page lists the signs and what happens next. At CION Cancer Clinics, our haematology team plans myeloma and lymphoma care with you, discussed at a tumour board and explained in plain words.
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Medically reviewed by Dr. Basudev PokhrelConsultant Haematologist · last reviewed September 2026, next review due September 2027
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On this page
- What is spinal cord compression in myeloma?
- What are the symptoms of spinal cord compression?
- What happens after you reach the emergency department?
- What beliefs cause families to wait too long?
- What should you tell the emergency doctor?
- What happens afterwards, and what can this page not tell you?
- Common questions about spinal cord compression in myeloma
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What to do now
If someone with myeloma has new or worsening back or neck pain together with weakness or heaviness in the legs, numbness, unsteady walking, or new trouble passing urine or controlling the bowels, go to the nearest emergency department today or call 108. Say "myeloma" and "possible spinal cord compression". Do not wait to see if it settles, and do not wait for a morning appointment.
The short answer
What is spinal cord compression in myeloma?
It means myeloma in a bone of the spine, or a collapsed spinal bone, is pressing on the spinal cord or the nerves leaving it. The warning signs are back pain plus changes in the legs, bladder or bowels, and treating it within hours gives the strongest chance of keeping the ability to walk.
Why the spine is so often affected
Myeloma grows inside the bone marrow, and the bones of the spine are full of marrow. The disease can weaken a spinal bone until it cracks and collapses, or a soft mass of myeloma cells can grow out of the bone into the space around the cord.
Why time decides so much
The spinal cord carries messages between the brain and the legs, bladder and bowels. Pressure squeezes it and cuts its blood supply. Nerve damage that is caught early can often reverse. Damage that has been present for a long time is much less likely to recover. That is why doctors act the same day on symptoms alone, before any scan.
Many people with myeloma have back pain that is not compression. The difference is new pain, a change in the pain, or any change in the legs, bladder or bowels.Not sure whether this applies to you?
Ask an oncologistWhat to look for
What are the symptoms of spinal cord compression?
Symptoms often arrive in this order, but not always. Act on the early ones rather than waiting for the later ones.
Changing back or neck pain
Pain that is new, steadily worse, or different from the usual bone pain.
Often described as
- Worse when lying flat or at night
- Worse on coughing, sneezing or straining
- A band of pain around the chest or tummy
Legs that do not feel right
Heaviness, weakness, stumbling, or legs giving way. Numbness, pins and needles or a feeling of walking on cotton wool.
Bladder and bowel changes
Difficulty starting to pass urine, not being able to pass it, leaking, or new constipation or loss of control. These are late signs and need help immediately.
Numbness in the saddle area
Numbness around the buttocks, genitals or inner thighs. It is easy to feel embarrassed about mentioning this. Please mention it, because it changes how fast doctors act.
At the hospital
What happens after you reach the emergency department?
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Examination and keeping the spine still
A doctor checks strength, feeling and reflexes in the legs. If the spine may be unstable, you may be asked to lie flat and be moved carefully until a scan is done.
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A steroid straight away
Dexamethasone is usually started quickly to reduce swelling around the cord and to act on myeloma cells. It is often given before the scan result is back.
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An MRI of the whole spine
An MRI, a scan using magnets, shows the cord and every level where pressure might be. It should be done urgently, not at the next available routine slot.
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Radiotherapy or surgery
Radiotherapy is the usual treatment, because myeloma responds to it well. Surgery may be advised when the spine is unstable, when a bone fragment is pressing on the cord, or when weakness is getting worse quickly. Not everyone is fit for surgery, and the team will explain why.
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Myeloma treatment and rehabilitation
Medicines for the myeloma follow or continue. Physiotherapy starts as soon as it is safe, to rebuild strength and balance.
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Commonly believed
What beliefs cause families to wait too long?
"Back pain is normal at his age."
Back pain is common, but in someone with myeloma, new or changing back pain is a reason to call the treating team. If it comes with any leg, bladder or bowel change, it is a reason to go to emergency care.
"We will wait until the weakness is obvious."
By the time someone cannot walk, the chance of full recovery is lower. Mild heaviness or unsteadiness is the moment to act, not a sign to wait for more.
"A massage or oil treatment will ease it."
Pressing or manipulating a weakened spine can cause more damage. Avoid massage, traction or bone-setting on the back until the team has seen a scan.
"The MRI can wait until the weekend is over."
Suspected cord compression is one of the situations where an urgent scan is justified at any hour. If the scan cannot be done where you are, ask where the nearest one is.
At the emergency desk
What should you tell the emergency doctor?
- That the patient has myeloma, and the name of the treating haematologist
- When the back pain changed and when the leg symptoms started
- Any trouble passing urine, leaking, or loss of bowel control
- Any numbness around the buttocks or inner thighs
- Previous scans of the spine, and any radiotherapy already given
- All current medicines, especially steroids and blood thinners
Being straight with you
What happens afterwards, and what can this page not tell you?
Recovery depends mostly on how much strength remained when treatment started and how quickly the symptoms came on. People who were still walking when treated are more likely to keep walking. Some regain strength over weeks. Some are left with weakness or need help with the bladder, and rehabilitation continues at home.
Protecting the spine at home
Follow the lifting and movement advice you are given, and ask whether a brace or walking aid is needed. Arrange the home so the person does not have to climb stairs often, and keep a clear path to the toilet at night. Report any return of pain or leg symptoms the same day.
Looking after the carer too
Caring for someone with weak legs is physically hard. Ask the physiotherapist to show the family how to help with standing, turning in bed and getting to the toilet without hurting their own backs. Ask about pressure sores, which can develop quickly in someone who cannot move much, and how to check the skin each day.
What the page cannot tell you
It cannot tell you whether a particular back pain is compression. Only an examination and an MRI can. It also cannot tell you how much recovery to expect, which your treating team will judge as the weeks pass. CION's haematology team works with radiation oncology and coordinates spinal surgery with qualified centres when it is needed.
Questions we are asked
Common questions about spinal cord compression in myeloma
Can spinal cord compression be the first sign of myeloma?
Yes. Some people learn they have myeloma only after arriving with back pain and weak legs, when a scan shows a collapsed spinal bone or a mass. Blood and urine protein tests and a bone marrow test then confirm the diagnosis, while the spine is treated urgently.
Should he lie flat while we travel to hospital?
If moving makes the pain much worse, or the legs are weak, lying as flat and still as is comfortable is sensible. Avoid twisting or bending. Calling 108 lets trained staff move him safely. Do not delay the journey trying to arrange the perfect position.
Why start steroids before the MRI?
Steroids reduce swelling around the cord and can protect nerve function while the scan and treatment are arranged. They can raise blood sugar and disturb sleep, so the team monitors these. Never start or change a steroid dose at home on your own.
Is radiotherapy to the spine safe?
It is the usual treatment and is generally well tolerated. Side effects depend on the area treated and can include tiredness, feeling sick or a sore throat or stomach for a short time. Your radiation oncologist will explain what to expect for your own plan.
Who needs surgery rather than radiotherapy?
Surgery is considered when the spine is unstable, bone fragments are pressing on the cord, or weakness worsens despite treatment. It suits people fit enough for an operation. Many people are treated with radiotherapy alone, and the choice is made together by the specialists involved.
Will he walk again?
No page can answer this for one person. The strongest influence is how much strength he had when treatment began. Physiotherapy matters a great deal. Ask the team what they expect after a few weeks, and what signs of progress to watch for.
Can it happen again?
Yes, at the same level or a different one, especially if the myeloma becomes active again. Know the symptoms, keep a copy of the latest spine scan, and act on new back pain with any leg, bladder or bowel change straight away.
Can bone injections prevent it?
Bone-protecting medicines such as zoledronic acid or denosumab lower the chance of fractures, including collapse of spinal bones. They cannot prevent every case, particularly when a mass grows out of the bone. Keeping myeloma treatment on schedule matters too.
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Sources
- Cancer Research UK — Physical effects of cancer, including spinal cord compression
- Macmillan Cancer Support — Impacts of cancer: spinal cord compression
- NICE — Spinal metastases and metastatic spinal cord compression (NG234)
- NHS — Multiple myeloma
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Bone Disease in Myeloma: Fractures and Bone PainWhy myeloma weakens the bones of the spineHypercalcaemia in Myeloma: An EmergencyThe other myeloma emergency families should knowZoledronic Acid and Denosumab in MyelomaInjections that lower the chance of fracturesRadiation therapy guideHow radiotherapy to the spine is planned
Talk to us
Back pain and myeloma worrying you?
If there is leg weakness, numbness or bladder change, go to an emergency department first. For everything else, tell us what has been found and CION's haematology team will help with the next step.