Malignant Spinal Cord Compression

Question 1

What is the earliest and most common symptom of spinal cord compression?

Answer 1

Back pain is the earliest and most common symptom of spinal cord compression

Question 2

True or false: Spinal cord compression is an oncological emergency

Answer 2

True

Question 3

True or false: Back pain is the earliest and most common symptom of malignant spinal cord compression.

Answer 3

True

Back pain is the earliest and most common symptom of malignant spinal cord compression. It may be worse when lying down or coughing.

Question 4

What are the key features of spinal cord compression?

Answer 4

• Back pain (earliest and most common)
• Lower limb weakness
• Sensory changes
• Neurological signs (dependent on site of lesion)

Question 5

What neurological signs might feature in spinal cord compression?

Answer 5

Neurological features of MSCC are dependent on the level of the lesion.

Lesions above L1 usually result in upper motor neuron signs in the legs. Lesions below L1 usually cause lower motor neuron signs in the legs and perianal numbness.

UMN signs: Spastic weakness, hypertonia, hyperreflexia, positive Babinski.

LMN signs: Flaccid weakness, hypotonia, hyporeflexia, fasciculations.

Question 6

What investigation is required is malignant spinal cord compression is suspected?

Answer 6

Urgent whole spine MRI (within 24 hours)

Question 7

How is malignant spinal cord compression managed?

Answer 7

High-dose oral dexamethasone (commence as soon as suspected, even before MRI).

Urgent oncology assessment for consideration of radiotherapy or surgery.