SPINAL CORD COMPRESSION (SCC)
|Lifetime incidence of SCC in cancer patients:1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36 ||1–6% |
|Median overall survival of patients with SCC: ||3–16 months |
|SCC as the initial manifestation of cancer: ||20–30% of all cases of SCC |
|SCC as the initial manifestation of cancer: || |
Cancer of unknown primary
SCC distribution along spine:
|Sites of Involvement ||Percentage of SCC ||Histology (% Among All Cases) |
|Extradural metastases:✫ ||90–95 || |
Prostate cancer (15–20%)
Breast cancer (15–20%)
Lung cancer (15–20%)
Non-Hodgkin lymphoma (5–10%)
Multiple myeloma (5–10%)
Renal cancer (5–10%)
|Intradural masses: ||5–10 || |
Nerve sheath tumors
Large leptomeningeal metastases
|Transforaminal progression of paravertebral tumor: ||Uncommon || |
|Primary hematogenous seeding to epidural space: ||Rare || |
✫The most common mechanisms are:
Direct extension into the epidural space of a hematogenous metastasis to a vertebral body
Pathologic fracture of a vertebral body infiltrated by a metastatic deposit resulting in cord injury by a bone fragment or spinal instability
Spinal cord compression has been associated with most cancers. Consequently, any patient with cancer and new back pain or a change in character of preexisting back pain should receive appropriate evaluation
Differential diagnosis of SCC:
Hypertrophic arthritic changes
Myelopathy secondary to intrathecal chemotherapy
Suspected spinal cord compression requires immediate imaging studies and consultation with a radiation oncologist and a neurosurgeon
Because multiple spinal epidural metastasis are found in one-third of patients it is recommended that the entire spinal cord be imaged, or at least the thoracic and lumbar spine in addition to the symptomatic region
|Back pain ||95% |
|Weakness ||60–85% |
|Sensory deficits ||40–90% |
|Autonomic dysfunction ||50% |
|Ataxia ||5% |
|Imaging Studies |
|Gadolinium-enhanced MRI || |
|CT scan || |
|Myelography || |
Myelography and postmyelogram CT is used for patients in whom MRI is contraindicated (such as patients with pacemakers, mechanical valves, and other metal implants)
Myelography is contraindicated in the presence of brain masses, thrombocytopenia, or coagulopathy, and has a small risk of worsening the neurologic deficit from pressure shifts in the event of complete spinal subarachnoid block
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