Background

Question 1

What % of cancer pts develop cord compression?

Answer 1

5%–10% of cancer pts develop cord compression.

Question 2

What is the MS in pts with cord compression?

Answer 2

MS in pts with cord compression is ∼3 mos (dependent on Hx of primary, extent of visceral/osseous met, degree of motor dysfunction, and PS).

Question 3

What is the most important prognostic factor?

Answer 3

Pre-Tx ambulatory status directly influences functional outcome and survival.

Question 4

What are 3 routes of metastatic spread to the spine?

Answer 4

Routes of metastatic spread to the spine: hematogenous, direct extension, and CSF. (Abeloff’s Clin Oncology, 5th ed., 2014)

Question 5

What malignancies commonly cause cord compression?

Answer 5

Lung, breast, and prostate each account for 15%–20% of cases, whereas renal cell, lymphoma, and multiple myeloma each account for 5%–10% of cases of cord compression.

Question 6

What is the most common site of origin?

Answer 6

Cord compression origin: epidural (extradural) in 95% > leptomeningeal (intradural extramedullary) in 4%–5% > intramedullary in 0.5%–1%

Question 7

How do pts with cord compression present?

Answer 7

Presenting Sx of cord compression: back pain, radicular pain, weakness, sensory deficits, bowel/bladder dysfunction, and paralysis

Question 8

What is the most common presenting Sx of cord compression?

Answer 8

The most common Sx of cord compression is back pain present in 90%–95% of pts (often precedes neurologic Sx > 2 mos).

Question 9

Describe the presentation of cauda equina syndrome.

Answer 9

Presenting Sx of cauda equina syndrome: pain, LE weakness, sensory disturbance (“saddle anesthesia”), and autonomic dysfunction including urinary retention and fecal incontinence

Question 10

What is the pathophysiology of cord compression?

Answer 10

Gradual progression results in epidural venous congestion, vasogenic edema, and demyelination (potentially reversible) while rapid progression results in disruption of arterial blood resulting in ischemia and cord infarction (irreversible).

Question 11

What part of the vertebra is most commonly involved by metastatic Dz?

Answer 11

Metastatic Dz typically involves the vertebral body rather than the post elements. Compression originates directly from the vertebrae (85%–90%) or via neural foramina extension (5%–10%).

Question 12

What part of the spine is most often involved in cord compression?

Answer 12

The T spine (70%) is most commonly affected by cord compression > lumbosacral (20%) > cervical (10%).