Spinal Cord Compression

Clinical manifestations

• Metastases located in vertebral body extend and cause epidural spinal cord compression

• Prostate, breast, and lung cancer are the most common causes, followed by renal cell carcinoma. NHL. and myeloma

• Site of involvement: thoracic (70%). lumbar (20%). cervical (10%)

• Signs and symptoms: pain (96%). weakness, autonomic dysfunction (urinary retention. 1 anal sphincter tone), sensory loss Diagnostic evaluation

• Always take back pain in Pts with solid tumors very seriously

• Do not wait for neurologic signs to develop before initiating evaluation b c duration &

severity of neurologic dysfunction before Rx are best predictors of neurologic outcome

• Urgent whole spine MRI is study of choice

Treatment

initiate immediately while awaiting imaging if back pain ♦ neurologic deficits

• Emergent XRT or surgical decompression if confirmed compression neuro deficits

• Neurosurgery superior to XRT in regaining neuro fxn for solid tumors (lane« 2005:366:643)

• If pathologic fracture causing compression -*■ surgery: if not surgical candidate -* XRT

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