Spinal Cord Compression, Malignant

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

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

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

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