Neoplastic Spinal Cord Compression

Question 1

Describe neoplastic spinal cord compression

Answer 1

Oncological emergency
Affects up to 5% of cancer patients.

Question 2

What type of compression occurs in the majority of cases of neoplastic spinal cord compression?

Answer 2

Extradural compression, usually due to vertebral body metastases

Question 3

Neoplastic spinal cord compression is more common in which 3 cancers?

Answer 3

Lung
Breast
Prostate

Question 4

What is the earliest and most common symptom of neoplastic spinal cord compression?

Answer 4

Back pain
Worse on lying down + coughing

Question 5

List 4 features of neoplastic spinal cord compression

Answer 5

Back pain
Lower limb weakness
Sensory changes: sensory loss + numbness
Neurological signs depend on level of lesion

Question 6

What neurological changes are seen in neoplastic spinal cord compression?

Answer 6

Lesions above L1: UMN signs in legs + a sensory level.
Lesions below L: LMN signs in legs + perianal numbness. Tendon reflexes increased below level of lesion + absent at level of lesion

Question 7

What investigation is required for suspected neoplastic spinal cord compression?

Answer 7

Urgent whole spine MRI
(within 24h)

Question 8

Describe management of neoplastic spinal cord compression

Answer 8

High-dose oral Dexamethasone (prior to Ix)
Urgent oncological assessment for consideration of radiotherapy or surgery