Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 39-25: Cancer-Related Spinal Cord Compression + Key Features Download Section PDF Listen +++ ++ Complication of metastatic solid tumor, lymphoma, or plasma cell myeloma (formerly multiple myeloma) Back pain is most common presenting symptom Prompt diagnosis is essential because once a severe neurologic deficit develops, it is often irreversible Emergent treatment may prevent or potentially reverse paresis and urinary and bowel incontinence + Clinical Findings Download Section PDF Listen +++ ++ Back pain (in > 80%) aggravated by lying down, weight bearing, sneezing, coughing Progressive weakness of the lower extremities Sensory loss (usually in the lower extremities) Late findings: bowel and bladder dysfunction progressing to incontinence + Diagnosis Download Section PDF Listen +++ ++ MRI Initial imaging method for patient who has cancer with new-onset back pain Should survey the entire spine to define all areas of tumor involvement for treatment planning purposes Has a sensitivity of 93% and a specificity of 97% for diagnosis of metastatic spinal cord compression Bone radiographs are neither sensitive nor specific for evaluating the cancer patient with back pain Whole-body positron-emission tomography with 18F-2-deoxyglucose may be useful as a screening procedure if back pain symptoms are nonspecific + Treatment Download Section PDF Listen +++ ++ Dexamethasone (10–100 mg intravenously followed by 4–6 mg every 6 hours intravenously or orally) should be given immediately to patients with a known cancer diagnosis and epidural impingement on the spinal cord Emergent surgery should be performed in patients without a known diagnosis of cancer to Relieve impingement Obtain a pathologic specimen Preoperative corticosteroids should not be given since they might induce a tumor response and compromise the pathology results Surgical decompression followed by radiation therapy is indicated for patients with a single area of compression due to solid tumors Fractionated radiation therapy is the preferred treatment option if multiple vertebral body levels are involved with cancer Corticosteroids are generally tapered toward the end of radiation therapy