![]() Surgery is associated with improved outcomes, but is not appropriate for many patients presenting with advanced symptoms of MSCC, such as paralysis, or those with a poor performance status, or cachexic state, as well as altered mental conditions, co-morbidities, surgical risks, and limited life expectancy. The standard of care in most cases is rapid initiation of corticosteroids in combination with either surgical decompression in case of an operable candidate, followed by radiation therapy (RT) or RT alone. The goals of treatment in spinal metastases are pain control and improvement of neurological function in order to achieve better quality of life (QoL). It is an emergency that requires rapid decision making on the part of several specialists, given the risk of permanent spinal cord injury or death. ![]() Patients often present with a history of progressive pain, paralysis, sensory loss, progressive spinal deformity, and loss of sphincter control. The median survival of patients with metastatic spinal cord compression is about 12 weeks, reflecting the generally advanced nature of the underlying malignant disease.Malignant spinal cord compression (MSCC) is one of the most devastating complications of cancer. Once complete paralysis has been present for more than about 24 hours before treatment, the chances of useful recovery are greatly diminished, although slow recovery, sometimes months after radiotherapy, is well recognised. lymphomas, small-cell lung cancer) and may be treated with chemotherapy alone. Some tumours are highly sensitive to chemotherapy (e.g. It is very effective as pain control and local disease control. Emergency radiation therapy (usually 20 grays in 5 fractions, 30 grays in 10 fractions or 8 grays in 1 fraction) is the mainstay of treatment for malignant spinal cord compression. Postoperative radiation is delivered within 2–3 weeks of surgical decompression. ![]() It is also occasionally indicated in patients with little hope of regaining function but with uncontrolled pain. Surgery is indicated in localised compression as long as there is some hope of regaining function. It may be given orally or intravenously for this indication. Treatment ĭexamethasone (a potent glucocorticoid) in doses of 16 mg/day may reduce edema around the lesion and protect the cord from injury. Lhermitte's sign (intermittent shooting electrical sensation) and hyperreflexia may be present.ĭiagnosis is by X-rays but preferably magnetic resonance imaging (MRI) of the whole spine. Symptoms suggestive of cord compression are back pain, a dermatome of increased sensation, paralysis of limbs below the level of compression, decreased sensation below the level of compression, urinary and fecal incontinence and/or urinary retention. Regardless of the pace, spinal cord compression will predictably progress over time. Acute compression may follow subacute and chronic compression, especially if the cause is abscess or tumor. Acute compression develops within minutes to hours. Subacute compression develops over days to weeks. In some patients, however, the condition may worsen more rapidly. Typically, the symptoms of spinal cord compression develop slowly and progress steadily over several years. Tumors that commonly cause cord compression are lung cancer (non-small cell type), breast cancer, prostate cancer, renal cell carcinoma, thyroid cancer, lymphoma and multiple myeloma. in tuberculosis) are equally capable of producing the syndrome. The most common causes of cord compression are tumors, but abscesses and granulomas (e.g. When acute it can cause a medical emergency independent of its cause, and require swift diagnosis and treatment to prevent long-term disability due to irreversible spinal cord injury. Causes can be bone fragments from a vertebral fracture, a tumor, abscess, ruptured intervertebral disc or other lesion. Spinal cord compression is a form of myelopathy in which the spinal cord is compressed. Compressive myelopathy at the C6-C7 level due to disc protrussion
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