Spinal cord compression - Oncological emergencies

Oncological emergencies - Spinal cord compression

Spinal cord compression present in 5% of patient with cancer. It is the most common complication of disseminated cancer. Spinal cord compression is associated with a lot of tumor. However it is most commonly present with prostate cancer and multiple myeloma.It is important to swiftly make the diagnosis and administered the treatment as quickly as you can to avoid paraplegia and increase the chance of survival for 30% of patient with spinal cord compression for one year. Early treatment avoid extensive neurological damage as residual neurological deficit reflects deficits of the initial treatment. Extradural metastases from renal carcinoma, prostate carcinoma, lymphoma, lung carcinoma and breast carcinoma nearly always lead to neoplastic cord compression. The compression commonly present as a result of the extension of the paraspinal metastases to the intervertebral foramina or posterior expansion of vertebral metastases.This condition will leads to vasogenic odema,arterial compromise and venous occlusion of the spinal cord which leads to myelopathy. The compression mostly affect thoracic spine ( 70 % ) , lumbar spine ( 20%) and cervical spine ( 10% ).

Patient with spinal cord compression initially complains of vertebral pain while lying flat or coughing. This is follow by sensory changes in sense in one or two dermatomes below the level of compression. If the patient suffered from cancer, urgent investigation is required if the patient complains of back pain, focal weakness and bowel or bladder dysfunction with a sensory level. This condition will later progress to motor weakness distal to the compression follows by sphincter disturbance. Patient will suffer from double incontinence and sever neurological deficit if left untreated.

Oncological emergency should also include spinal cord compression. To prevent further neurological deficit, intravenous corticosteroid is administered initially on the clinical ground suspicion. The diagnostic procedure that is required for the detection of the spinal cord compression include plain X ray to identify any vertebral collapse or MRI scan of the spinal axis to identify the level of spinal cord compression. Images of the whole spine is important as 20% to 30% of patient may present with multiple spinal cord compression. If the level of compression has been irridated or vertebral instability present, and opinion from the neurosurgeon is essential regarding the possibility of performing surgical decompression. Urgent local radiotherapy is the definite treatment if opinion is not available.

Adequate analgesic is important while performing urgent local radiotherapy. Pre treatment ambulatory function is important as it determines the post operative gait function. Gait and continence preservation is important in term of the purpose of the treatment.