SPINAL CORD COMPRESSION

Incidence – Spinal cord compression affects 5% of patients with advanced cancer.

«  It is a medical emergency. Treatment within 24 to 48 hours can sometimes restore function.

Presentation – Spinal cord compression usually occurs in advanced disease, but in 8% of patients it is the presenting feature.

  Typical features and
common sequence

% at diagnosis

Back pain 95
Weakness (both legs)

75

“Funny feelings” (both legs) 50
Urinary hesitancy or retention

50

Loss of rectal sensation (late)

«  Motor and sensory loss may be denied by a frightened patient. Examine carefully for a sensory level.

Investigations - Plain x-ray may show bone destruction, loss of a pedicle or vertebral body collapse (sparing of the intervertebral discs is a classical sign of malignant damage).

Myelogram can give valuable information about site and extent of the compression.

CT scan can be useful to delineate soft tissue masses.

«  It is essential that investigations do not delay treatment.

Management options:

  1. Immediate high dose steroids

  2. Same day radiotherapy

  3. Surgical decompression

1. Steroids – Give an immediate dose of dexamethasone 30mg IV as soon as possible.

2. Same-day radiotherapy is most suitable for direct extradural compression of the cord by radio-sensitive tumor deposits (myeloma, lymphoma, leukemia). It cannot restore stability to an already collapsed vertebra.

The results of radiotherapy are better than surgery with less morbidity. If treatment is started within 48 hours of signs occurring there is a chance of complete recovery. Treatment is usually 3,000cGy over 10 to 14 days.

3. Surgical decompression usually should only be considered if:

  • Diagnosis is in doubt (biopsy possible)

  • Symptoms worsen during radiotherapy

  • Patient has already had maximum radiotherapy

  • Tumors are radiotherapy resistant

Results are disappointing in terms of mobility. 75% of patients present when already unable to walk, when the chances of restoring mobility are poor. Overall only 35% retain or return to the ability to walk.

Nevertheless treatment may still be worthwhile for the patient, even when prognosis is short, if it is possible to rescue sphincter function, and thus avoid the demoralizing symptoms of incontinence.

Prevention—Prophylactic radiotherapy should be considered if a patient has thoracic metastases with any degree of vertebral collapse, since this can prevent total vertebral collapse and spinal cord compression. A spinal support corset and advice on avoiding lifting or twisting can be important.


The author and publisher have taken precautions to ensure that the information in this book is error-free. However, readers must be guided by their own personal and professional standards of good practice in evaluating and applying recommendations made herein. The contents of this book represent the views and experience of the author, and not necessarily those of the publisher.


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