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n_spinalcordcomp

acute spinal cord compression

Acute spinal cord compression:

common tumours:

  • breast carcinoma
  • lung carcinoma
  • NHL & Hodgkin's lymphoma
  • multiple myeloma
  • prostate carcinoma

summary:

  • 65% thoracic, 20% lumbosacral spine, 15% cervical
  • May be first sign of neoplasm/ complicate pre-existing disease
  • Result from bleeding, infection, fracture
  • > 95 % long Hx (weeks ⇒ months) of back pain prior to Dx/other symptoms
  • minimal weakness may ⇒ profound, irreversible weakness over hrs ⇒ rapid Rx
  • myelopathy symptoms and signs are late findings
    • ⇒ once present, neurological deterioration increasingly rapidly

symptoms:

  • continuous, localised back pain, progressive in severity and duration
  • pain requiring analgesia
  • +/- radicular (bilateral with thoracic spine) as nerve root compressed
  • NB: lymphoma deposits may be painless
  • myelopathy: 
    • weakness ⇒ complete paralysis
    • decreased sensation
    • urinary retention
    • difficulty walking

signs:

  • may be subtle/ absent (does not exclude significant SC compression)
  • localised spinal tenderness on percussion
  • sensory level
  • symmetrical weakness + hyporeflexia (very early)
  • spasticity + hyperreflexia (later)
  • decreased rectal sphincter tone
  • abnormal gait

general exam: 

  • looking for evidence of the primary tumour

investigations:

  • plain Xrays:
    • show evidence of tumour in 90% of vertebral metastases but now largely replaced by MRI scanning
    • any patient with unexplained persistent, progressive back pain of > 1 month duration, especially if > 50 years of age, known malignancy, persistent, progressive back/neck pain
  • emergent MRI or, if MRI not available, CT myelogram

management:

  • high dose corticosteroids ⇒ IV dexamethasone ? dose 4mg- 20mg
  • immediate neurosurgical consultation
  • radiotherapy is definitive treatment for most
  • surgical laminectomy and decompression if: architectural instability, tissue confirmation required, max. XRT given, tumor radio-resistant

References

n_spinalcordcomp.txt · Last modified: 2018/09/24 13:21 by wh