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
Typical features and
% at diagnosis
Weakness (both legs)
“Funny feelings” (both
Urinary hesitancy or
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.
can be useful to delineate soft tissue masses.
It is essential that investigations do not delay treatment.
high dose steroids
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
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.
Surgical decompression usually should only be considered
is in doubt (biopsy possible)
worsen during radiotherapy
has already had maximum radiotherapy
are radiotherapy resistant
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.