Suspected epidural compression of the spinal cord and cauda equina by metastatic carcinoma clinical diagnosis and survival

Abstract

Data from 133 patients with cancer and suspected compression of the spinal cord or cauda equina was reviewed. Although there were differences in presenting symptoms and signs between the group of 62 patients with compression and the 71 without, no single symptom or sign discriminated adequately between the two groups. Multiple logistic regression was used to try to develop an index of signs and symptoms which could identify those without compression, thereby sparing them a myelogram. Eight characteristics, in combination, proved most effective as an index, but they were not perfect predictors of patients with block. Final diagnoses in the group without compression were: vertebral metastases 35%, carcinomatous meningitis 24%, plexopathy and/or neuropathy 21%, other 30% (10% had two diagnoses). Sixty‐six percent of those with compression and 50% of those without compression died within six months, although patients rarely survived for much longer.

Perfil epidemiológico de pacientes com metástase na coluna vertebral em Salvador, Bahia, Brasil

“…13 Em nossa amostra, a faixa etária variou de 16 a 81 anos de idade, com mediana de 56 anos (IIQ: 45-64), concordante com dados da literatura. [14][15][16][17][18][19][20][21][22] T3 T4 T5 T6 T7 T8 T9 T10 T11 T12 L1 L2 L3 L4 L5 S1 Em nosso estudo, observou-se uma discreta predominância do sexo masculino em relação ao sexo feminino (proporção de 1,2:1). Em revisão de literatura, encontramos que ambos os sexos são acometidos de maneira semelhante 19,23,24 , porém, em alguns estudos, há maior prevalência no sexo masculino, também de forma discreta.…”

“…Em revisão de literatura, encontramos que ambos os sexos são acometidos de maneira semelhante 19,23,24 , porém, em alguns estudos, há maior prevalência no sexo masculino, também de forma discreta. 7,14,15,25 Sciubba et al justificam que este fato provavelmente ocorre devido à prevalência ligeiramente maior de câncer de pulmão nos homens, e de câncer de próstata quando comparado ao de mama em mulheres. 7 As metástases vertebrais ocorrem mais frequentemente na região lombar (70%), seguida da torácica (20%) e cervical (10%).…”

Presenting symptoms of neoplastic spinal cord compression

“…Back pain, leg weakness, urinary retention, and leg numbness have been noted as the more common presenting symptoms of neoplastic spinal cord compression in other studies [1,2,3]. However, these studies did not address delays in diagnosis with regard to symptomatology.…”

Metastatic epidural spinal cord compression: current concepts and treatment

“…However, less than 50% of patients with malignancy, considered clinically to have metastatic epidural spinal cord compression, will have this diagnosis confirmed by myelography [43]. Myelography in cancer patients with back pain and myelopathy is normal in 23% of patients, and with back pain and radiculopathy is normal in 37% of patients [44].…”