Malignant spinal cord compression

Background

• Suspect in pt w/ known cancer (esp lung, breast, prostate) + back pain
• Occurs in thoracic location in 70% of pts

Clinical Features

• Back pain (90% of pts)
  • Progressive and worse when supine
• Motor weakness (proximal legs)
• Sensory changes and bladder or bowel dysfunction (late findings)

Diagnosis

• MRI: modality of choice
• CT myelography: use if MRI unavailable

Treatment

1. Corticosteroids
   1. Dexamethasone 10mg IV followed by 4mg PO or IV q6hr
   2. Consider starting in ED if imaging is delayed
2. Radiotherapy (emergent)

Source

Tintinalli