Don't Wait for a Sensory Level–Listen to the Symptoms: a Prospective Audit of the Delays in Diagnosis of Malignant Cord Compression

Levack, Pamela; Graham, John C.; Collie, David; Grant, Robin; Kidd, Jason; Kunkler, Ian; Gibson, Alexander; Hurman, David; McMillan, N.; Rampling, Roy; Slider, L.; Statham, Patrick; Summers, DM

doi:10.1053/clon.2002.0098

Cited by 239 publications

(154 citation statements)

References 16 publications

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“…the main cause of such unsatisfactory surgical results is the delay in diagnosis of plasma cell neoplasia of the spine. the postoperative neurological outcomes are similar to other studies, but there are minor differences depending the severity of the preoperative neurological deficit [6,8,12,13,14,19]. this study was supported by grant iga 7953-3 and 9225-3.…”

Section: Discussionsupporting

confidence: 84%

“…Durr, in a group of 27 operated patients with spinal affliction of MM found that 21 patients had normal preoperative neurological findings and in 6 cases a preoperative neurological deficit had developed [9]. In Levack's group of 248 patients with metastatic disease of the spine, of which 10% were MM, 82% of patients were not able to walk independently once the diagnosis was established [8]. In our study 13 patients (48%) were admitted bedridden prior to surgery.…”

Section: Discussionmentioning

confidence: 67%

“…Localized back pain is present in up to 94% of patients with spinal malignancies, developing an average of 3 months before the diagnosis is established [8]. Durr notes that out of 27 patients with MM of the spine all had back pain which developed over an average period of 5,8 months [9].…”

Section: Discussionmentioning

confidence: 99%

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Diagnosis and surgical therapy of plasma cell neoplasia of the spine

Rehák

Maisnar²,

Málek³

et al. 2009

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Presented is a retrospective analysis of 27 patients with plasma cell neoplasms of the spine treated by surgery. Multiple myeloma was confirmed in 22 (81%) and solitary plasmacytoma in 5 patients (19%), assessed at the time of surgery. Nineteen patients (70%) with the preliminary diagnosis of malignancy of unknown etiology were admitted for surgery. In 23 patients (85%) the essential symptom was back pain, which preceded surgery by an average of 4 months. Thirteen patients (48%) were bedridden due to tumor spinal cord compression, on average for 7 days before undergoing surgery. Only 5 out of 13 bedridden patients (38%) regained the ability to walk after surgery and 8 patients (62%) remained bedridden despite successful surgical decompression of the spinal cord. The difference of survival of the patients between bedridden and able to walk prior to surgery was statistically significant (Cox's F-Test = 0.005).

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 67%

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Diagnosis and surgical therapy of plasma cell neoplasia of the spine

Rehák

Maisnar²,

Málek³

et al. 2009

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“…It is wellknown that sensory levels do not always correlate well with the level of compression. 19,[23][24][25] In SCC, sensory abnormalities begin distally and ascend to form a distinct sensory level. 7 Additionally, lesions below the conus medullaris have been reported to cause symptoms earlier than lesions above it.…”

Section: Discussionmentioning

confidence: 99%

A case of indirect cauda equina syndrome from metastatic prostate cancer

Lefresne

Fairchild

Bistritz

et al. 2013

CUAJ

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We report the case of a patient with metastatic hormone refractory prostate cancer in whom "indirect" cauda equina syndrome developed concurrent with multilevel spinal cord compression (SCC). Three months after his first positive bone scan, a 65-yearold otherwise healthy man presented with severe back pain, bilateral lower extremity paresthesias, leg weakness and urinary retention. Magnetic resonance imaging (MRI) showed a dural-based mass causing SCC at the T9, T10 and T11 vertebrae, with a normal cauda equina. He received corticosteroids and palliative external beam radiotherapy, resulting in good pain control and gradual improvement in his neurological symptoms. He did well for 8 months, at which time his residual bilateral leg weakness abruptly worsened and he experienced numbness, paresthesias, urinary incontinence and constipation. Repeat MRI showed progression of epidural metastatic disease compressing the spinal cord or thecal sac at 7 thoracic vertebral levels. The cauda equina was also distorted and flattened without evidence of direct solid tumour impingement. We hypothesized that the etiology was increased intrathecal pressure due to disrupted cerebrospinal fluid flow resulting from multiple levels of upstream thecal sac compression. It is essential to image the entire spinal cord and cauda equina when patients with metastatic bone disease present with neurological symptoms to institute correct treatment and preserve function and mobility.Can Urol Assoc J 2009;3(4):E31-E35 pathological fracture, an intramedullary lesion or a combination of these factors.5 Both oncological emergencies require early diagnosis and treatment to prevent the development of devastating and potentially irreversible neurological complications. We present a unique case of CES secondary to increased cerebrospinal fluid (CSF) pressure as a result of multilevel upstream malignant SCC in a patient with prostate cancer.

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“…5,6 Early recognition of these symptoms is of paramount importance as it may invariably proceed to paraplegia if not intervened early and otherwise results are dismal. 7 The gold standard diagnostic investigation to evaluate SCC is spinal magnetic resonance imaging (MRI), which allows a clear identification of bone lesions, tumor masses, and neural alterations like cord edema. 8 Decompressive laminectomy was frequently performed in the past but it is now not that propagated due to the residual instability of the vertebral column, possible delay in the initiation of anti-myeloma therapy after surgery and, above all, because of the excellent response of neoplastic cells to steroids and radiotherapy.…”

Section: Introductionmentioning

confidence: 99%

Transplant ineligible multiple myeloma patients presenting as paraplegia/paraparesis a prospective single institution study

et al. 2016

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INTRODUCTIONMultiple myeloma (MM) is a clonal B-cell disorder characterized by proliferation and accumulation of Blymphocytes and plasma cells in the bone marrow and, more rarely, at extra medullary sites.1 Spine is the bone site that is most frequently affected by MM-related lesions.2 Vertebral lesions can result in pain, permanent deformity, kyphosis, walking impairment, permanent disability, or paralysis. In almost 20% of the cases, spinal cord compression (SCC) may occur; diagnosis and treatment must be carried out rapidly in order to avoid a permanent sensitive or motor defect. 3It can be estimated that over 60% of bone lesions occurring in MM patients involve the spine, as compared with 90% in metastatic prostate cancer, 75% in breast cancer, and 45% in lung cancer. 4 Displacement and compression of the spinal cord can be caused by either epidural invasion by neoplastic tissue or by osseous fragments protruding from a fractured vertebral body. Pain is the first and most common presenting symptom. 5,6 The reason for the pain could be either, mechanical which becomes more intense in case of cough/exercise or radicular pain caused by nerve-root compression. Motor weakness is the second most ABSTRACT Background: Multiple myeloma a plasma cell neoplasm characterized by heterogeneous myriad of presentation with paraparesis or paraplegia in 20% cases due to spinal cord compression by vertebral collapse, compression or fracture. Methods: This is a prospective observational study of thirty transplant ineligible multiple myeloma patients with paraplegia/paraparesis. Pretreatment evaluation done as per standard protocol including MRI whole spine. Involved spine XRT 8Gy single fraction followed by BLD (Bortezomib 1.3mg/m 2 weekly once, Lenalidomide 10mg/m 2 for 21 days, oral dexamethasone 40 mg weekly once). Neurological parameters, time to neurological and tumor response at 6 months assessed. Patients in very good partial response or complete response were maintained on Lenalidomide and bisphosphonate therapy for a period of two years. The duration of symptoms and time to response were analyzed with Mann Whitney Cox test. Results: 15 patients were grade 0 power and others grade 1 or 2. Median time to any neurological response was 2.97 weeks. 63.3% of patients achieved power of grade 5, 30% grade 4 and 6.7% grade 3 powers. 23.3% patients received complete response while 63.3% patient's very good partial response. Conclusions: Bedridden myeloma patients had an excellent improvement in quality of life and tumor control with this treatment schedule.

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Don't Wait for a Sensory Level–Listen to the Symptoms: a Prospective Audit of the Delays in Diagnosis of Malignant Cord Compression

Cited by 239 publications

References 16 publications

Diagnosis and surgical therapy of plasma cell neoplasia of the spine

Diagnosis and surgical therapy of plasma cell neoplasia of the spine

A case of indirect cauda equina syndrome from metastatic prostate cancer

Transplant ineligible multiple myeloma patients presenting as paraplegia/paraparesis a prospective single institution study

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