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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
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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
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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
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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
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