Metastatic Spinal Cord Compression

Question 1

Epidemiology

Answer 1

10% of advanced cancer patients develop this

75% of cases - known cancer (lung, breast, prostate)
25% of cases - new cancer

Majority are thoracic

Question 2

Red flag symptoms

Answer 2

Progressive spinal pain, severe unremitting
Made worse by straining (coughing, sneezing, moving)
Band like pain
Local spinal tenderness
Nocturnal pain

Neuro symptoms

• radicular pain (shooting pains down limbs)
• limb weakness/sensory loss
• bladder, bowel dysfunction

Question 3

Signs

Answer 3

Point tenderness
UMN above L1- increased tone, weak legs/reduced sensation, increased reflexes, positive Babinski

LMN in cauda equina - saddle anaesthesia, reduced anal tone, urinary retention

Question 4

Urgency of investigations

Answer 4

Neurological symptoms and signs suggestive of MSCC => MRI within 24hrs

Pain suggestive of spine mets but no neuro signs or symptoms => MRI within 1wk

Question 5

Possible differentials

Answer 5

Mets
Primary tumour
Infection

Question 6

Investigations

Answer 6

Myeloma screen - MCSS more common in myeloma and prostate cancer
PSA

CXR, CTCAP
Tissue biopsy for diagnosis

Question 7

Management

Answer 7

Definitive treatment before further neurological deterioration
-start within 24hrs of MSCC confirmation

May involve

• surgery, RT, supportive
• rehab