Spinal Cord Compression

Question 1

Definition of spinal cord compression

Answer 1

Oncological emergency with extradural compression from vertebral body metastases

Question 2

Aetiology of spinal cord compression

Answer 2

Most commonly lung, breast, and prostate cancer
Primary bone tumours
Neuroblastoma and soft tissue sarcoma (<18yo)

Spinal epidural mets → mechanical injury to axons and myelin, and spinal cord ischaemia/infarction via compression of spinal arteries and the epidural venous plexus

Question 3

Epidemiology of spinal cord compression

Answer 3

Occurs in 5% of cancer patients
One of the most common and serious skeletal-related events for cancer patients
5-10 patients per 200 with terminal cancer will have MSCC

Question 4

Symptoms of spinal cord compression

Answer 4

Back pain (earliest, most common, worse on lying down and coughing)
Weakness or paralysis → unsteady gait or increased difficulty in walking, standing, or transferring
Numbness of paraesthesias
Sensory loss
Bladder or bowel dysfunction

Question 5

Differentials for spinal cord compression

Answer 5

Spinal epidural abscess
Osteoporotic spinal compression fracture
Intervertebral disc compression/herniation
Transverse myelitis
GBS

Question 6

Signs of spinal cord compression on examination

Answer 6

Above L1 → UMN signs + sensory level

Below L1 → LMN signs + peripheral numbness

Tendon reflexes will be increased below the level of the lesion and ABSENT at the level of the lesion

Question 7

Investigations for spinal cord compression

Answer 7

URGENT MRI spine (gadolinium enhanced): visualise the tumour

Bone profile: hypercalcaemia, raised ALP

CT spine: radiotherapy/surgery planning
X-ray spine: visualisation of fractures and mets
Tumour biopsy

Question 8

Management for spinal cord compression

Answer 8

1. High dose dexamethasone PO/IV
2. Surgery (Non-frail, single/fewer lesions)
3. Radiotherapy (frail, multiple lesions)

Supportive
- Thromboprophylaxis
- Fluids
- PPI e.g. omeprazole
- Bladder and bowel monitoring
- Risk assess for pressure ulcers
- Nutritional support

Question 9

Complications of spinal cord compression

Answer 9

Pressure ulcers
DVT/PE
Poor bladder emptying → UTI
Falls

Steroid use → PCP infection
Post-op autonomic dysfunction: orthostatic hypotension, heat intolerance, loss of bladder and bowel control, ED

Question 10

Prognosis of spinal cord compression

Answer 10

Dependent on performance status, duration of symptoms, mets etc.
May recur even after surgery/radiotherapy