Spinal Cord Compression
Summary of Key Points
Incidence
• Spinal cord compression is diagnosed in more than 30% of all patients with disseminated cancer, and roughly 5% to 10% of all patients experience cord dysfunction.
• Back pain is the most common presenting complaint and almost always precedes neurologic dysfunction.
• Spinal cord compression has a devastating effect on quality of life and is frequently diagnosed late.
Evaluation
• Any new or worsening back pain in a patient with cancer mandates urgent radiographic evaluation.
• Any evidence of myelopathy may signal impending catastrophic loss of cord function.
• Magnetic resonance imaging of the entire spine is the most rapid and cost-effective means of diagnosis and should be the first procedure performed.
Treatment
• Corticosteroids, conventional radiation therapy, and decompressive surgery are the mainstays of treatment.
• Although treatment of metastatic spinal lesions is considered palliative, aggressive medical and surgical treatment can significantly improve pain, neurologic function, and quality of life.
1. The most common presenting symptom of spinal cord compression from tumor is:
2. The most effective surgical technique for spinal metastatic pathological fracture (in the correct clinical context) with spinal cord compression is:
3. En bloc wide resection is the treatment of choice for which of the following tumors in the spine?
1. Answer: C. Pain is the most common and consistent symptom in patients with metastatic spine disease. Nocturnal pain or pain in the recumbent position in any patient with cancer is especially suspicious.
2. Answer: C. When feasible, ventral and dorsal decompression with stabilization is ideal for the treatment of symptomatic pathological fractures, especially if kyphosis exists.
3. Answer: A. Although some persons advocate en bloc resection for certain types of solitary metastatic lesions to the spine, wide en bloc spondylectomy is the treatment of choice for malignant primary spine tumors, such as chordomas or chondrosarcomas.
