Spinal Cord Compression

Abstract

Spinal cord disease represents a major cause of morbidity and suffering in cancer patients. Prevention or minimization of neurologic deficits depends on an understanding of early symptoms, clinical course, and treatment options. Early diagnosis is crucial, as current treatments usually arrest the course of the disease but much less commonly restore lost neurologic function. This article will review the epidemiology, pathophysiology, symptomatology, diagnosis, and management of the causes of spinal cord dysfunction directly related to cancer. It will briefly discuss myelopathies related to paraneoplasia and treatment complications. Epidural spinal cord compressionSpinal cord or cauda equina dysfunction resulting from tumor growth in the spinal epidural space is commonly referred to as epidural spinal cord compression (ESCC). In some ways, spinal epidural metastasis (SEM) may be a better term, as it encompasses the phenomena of root, cauda equina, and minor degrees of thecal sac compression SEM/ESCC is the most common cause of spinal cord dysfunction in cancer patients, and will receive the bulk of attention in this article. EpidemiologyAlthough careful, contemporary population-based studies are unavailable, the best evidence suggests that 5% of patients dying of cancer have suffered ESCC [1]. With more than 500,000 Americans succumbing to cancer yearly, there are likely to be more than 25,000 cases of ESCC yearly in the United States.Neurol Clin N Am

Metastatic spinal cord compression: diagnosis and management

“…2-9 The strongest predictor of neurologic outcome with treatment is the neurologic status when treatment is initiated. 10 A large, well designed German retrospective cohort study found an association between slower development of motor deficits before the start of radiotherapy and a better functional outcome after treatment. 11…”

“…15 It also improves outcomes (including reducing local recurrence rates) after surgery and in patients who are not surgical candidates. 10 There are three goals of treatment with radiotherapy:…”

“…25 Patients with spinal instability, good life expectancy, or radio-resistant tumours are likely to have a much better neurological outcome with tumour resection and spinal stabilisation before radiation. 10 The Spinal Instability Neoplastic Score (SINS) is a validated tool to determine clinical instability (defined as "loss of spinal integrity as a result of a neoplastic process that is associated with movement-related pain, symptomatic or progressive deformity and/or neural compromise under physiological loads"). 26 A Canadian systematic review found no direct evidence to support the type of surgery best undertaken nor whether surgical salvage should be attempted if a patient is progressing on or shortly after radiotherapy.…”

Defining spinal instability and methods of classification to optimise care for patients with malignant spinal cord compression: A systematic review

“…Patients with spinal instability have a better neurological outcome with tumour resection and surgical stabilisation prior to radiotherapy. 19 …”

Survival score scales of patients operated with spinal metastases: retrospective application in a Brazilian population

“…Some authors state a minimum of 3-month life expectancy to consider operative treatment 5 , and others extend this limit to about 6 months 4,6 . Therefore, predicting survival is the key factor in selecting the proper treatment modality 6,7 .…”