Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ SPINAL CORD COMPRESSION (SCC) ++ Etiology Table Graphic Jump Location | Download (.pdf) | Print Etiology 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: Lung cancer Cancer of unknown primary Non-Hodgkin lymphoma Multiple myeloma SCC distribution along spine: Thoracic spine: Lumbar spine: Cervical spine: 60–80% 15–30% 4–13% 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 Meningioma Nerve sheath tumors Large leptomeningeal metastases Transforaminal progression of paravertebral tumor: Uncommon Lymphomas Neuroblastomas 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 ++ Work-up Table Graphic Jump Location | Download (.pdf) | Print Work-up 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: Epidural abscess Subdural abscess Hematoma Herniated disc Leptomeningeal disease Hypertrophic arthritic changes Radiation myelopathy 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 Symptoms Back pain 95% Weakness 60–85% Sensory deficits 40–90% Autonomic dysfunction 50% Ataxia 5% Imaging Studies Gadolinium-enhanced MRI The standard for diagnosis of spinal cord compression Sensitivity: 93%; specificity: 97%; overall diagnostic accuracy: 95% CT scan Useful for assessing the degree of bone destruction and whether bone or tumor is causing spinal cord compression 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 ++ Treatment Strategies Supportive care Pain frequently is resistant to standard ... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth