Metastatic Spinal Cord Compression

Question 1

Why is Cauda equina often mention with MSCC? (2 points)

Answer 1

1. They have similar pathophysiological processes
2. So CE caused by cancer is a subtype of MSCC

Question 2

What percentage of cancer pt will develop Metastatic lesions affecting Spinal Cord?

Answer 2

5-10%

Question 3

What is the causes of MSCC? (3 things)

Answer 3

1. Secondary to metastatic deposits within spinal column (most common)
2. Secondary to Mechanical dysf (structural weakness bc other cancer)
3. Primary CNS tumours

Question 4

What are the cancers that most commonly cause MSCC? (5 things)

Answer 4

1. Lung cancer
2. Breast cancer
3. Kidney cancer
4. Prostate cancer
5. Thyroid cancer

Question 5

Where in the spine does MSCC usually happen?

Answer 5

1. Thoracic spine (60%)
2. Lumbar spine (30%)
3. Cervical spine (10%)

Question 6

What are the CF of MSCC? (5 things)

Answer 6

1. Back pain (95%)
2. Weakness (symmetrical) (85%)
3. Sensory symptoms
4. Sphincter dysf
5. Cauda equina syndrome (if CE part of spine affected)

Question 7

When is the Back pain in MSCC worse?

Answer 7

@ coughing / straining

Question 8

How does Sphincter dysf in MSCC present? (2 things)

Answer 8

1. Urinary retention / incontinence
2. Faecal incontinence

Question 9

What is the GOLD standard investigation for MSCC Dx?

Answer 9

MRI

Question 10

What is the use of MRI in MSCC Dx? (2 things)

Answer 10

1. Accurate identification of compression site
2. Can determine extent of disease

Question 11

What is important about investigating sus MSCC?

Answer 11

It is an oncological emergency, needs rapid investigation + Mx

Question 12

What are the General Initial Mx options for MSCC? (3 things)

Answer 12

1. Analgesia
2. VTE prophylaxis (bc cancer = VTE risk)
3. Catheter (if any bladder dysf)

Question 13

What are the VTE prophylaxis options for MSCC pt? (2 things)

Answer 13

1. TED stockings
2. Prophylactic LMWH

Question 14

What is a more specific Initial Mx option for MSCC?

Answer 14

Dexamethasone (high dose)

Question 15

What is the use of Dexamethasone in MSCC Mx?

Answer 15

Reduces oedema –> relieves compression

Question 16

What are the Definitive Mx options for MSCC? (2 things)

Answer 16

1. Surgery + Radiotherapy
2. Radiotherapy (if can’t undergo surgery)

Question 17

What are the Surgical Mx options for MSCC? (3 things)

Answer 17

1. Surgical decompression + Reconstruction
2. Vertebroplasty (if can’t undergo full surgical decompression)
3. Kyphoplasty (if can’t undergo full surgical decompression)