Malignant spinal cord compression

Background

  • Suspect in patient with known cancer (esp lung, breast, prostate) + back pain
  • Occurs in thoracic location in 70% of patients

Clinical Features

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

Evaluation

  • MRI: modality of choice
  • CT myelography: use if MRI unavailable
  • Metastatic Bone Cancers
    • BTL with Pickles and Relish: Breast, Thyroid, Lung, Prostate, Renal

Differential Diagnosis

Oncologic Emergencies

Related to Local Tumor Effects

Related to Biochemical Derangement

Related to Hematologic Derangement

Related to Therapy

Management

  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)

See Also

Spinal Cord Compression (Non-Traumatic) [[Cauda equina

References