Spinal Cord Compression Flashcards
(21 cards)
Malignant spinal cord compression (MSCC) is most commonly seen in which cancers?
cancers that spread to bone
what are the 2 main types of MSCC and where are the most commonly found?
result of vertebral collapse
result of extradural mets
common site is thoracic spine
what are the typical features of pain in MSCC?
- thoracic pain (most common)
- radicular distribution ie radiating along affected dermatome
- worsening over preceding weeks/months
- worse with coughing/sneezing, movement, weight bearing
what are the typical sensory/motor symptoms of MSCC?
progressive leg weakness and sensory loss
what are the typical autonomic symptoms of MSCC?
urinary incontinence or retention
faecal incontinence
on examination
spinal tenderness UMNL findings loss of sensation below dermatomal level of compression (T10 sensory level suggests compression at T8 vertebral level) bladder - retention/incontinence reduced anal tone
what are examples of upper motor neurone findings
hypertonis
hyper-reflexia
clonus
upgoing plantars
gold standard investigation
MRI of whole spine
what can an MRI show
allows diagnosis
defines level of compression
identifies other levels of compression
allows assessment of stability of the spine
when would a CT scan be used
MRi contraindicated (eg pacemaker) patient is not previously know to have a diagnosis of cancer in order to identify primary site
what is another key investigation in suspected MSCC
serum Ca (raised)
what are the groups of management
supportive steroids surgery radiotherapy chemotherapy
how would you supportively manage a patient with MSCC
keep patient flat until stability of spine determined
urinary catheter if urinary retention
monitor bowel function + commence bowel regimen if required (laxatives/enemas)
physiotherapy
prophylactic dalteparin if bed-bound
what steroids would you give and why?
dexamethasone 8mg bd initially
- oral preferred but S/C or IV if required
helps reduced oedema around lesion
what should you keep in mind when giving steroids
side effects
- prescribe with fast-protection eg omeprazole
- monitor blood sugar (daily BM)
- minmise duration of high dose steroids- aim to reduce dose once definitive therapy started
when is surgery the preferred treatment
patient is fit with low volume met disease
LE >3 month
isolated posterior cord compression (decompression laminectomy may suffice)
good prior sensory/motor function
no prior history of cancer
strong remainder of spine
when is surgery generally avoided
frail patient with large volume met disease
prior poor morbidity
anterior compression (surgery would require vertebral body resection with stabilisation = MAJOR OP)
when is radiotherapy used
after surgery to reduce risk of recurrence
instead of surgery in patients not fit for theatre
how is radiotherapy delivered
targeted at the level of the spinal cord - 4 fractions delivered over 4 consecutive days
when is primary chemotherapy used
if the primary tumour is highly chemosensitive - eg germ cell tumours, lymphomas
if there is no surgical or radiotherapy option
prognosis
fully ambulant at diagnosis - 90% remain ambulant
not fully weight bearing or mobile waling aid - most unable to walk again independently
paraplegic - 10% become ambulant after treatment
***better prognosis is related to early diagnosis and management
