Metastatic Spinal Cord Compression Flashcards

1
Q

Why is Cauda equina often mention with MSCC? (2 points)

A
  1. They have similar pathophysiological processes
  2. So CE caused by cancer is a subtype of MSCC
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2
Q

What percentage of cancer pt will develop Metastatic lesions affecting Spinal Cord?

A

5-10%

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3
Q

What is the causes of MSCC? (3 things)

A
  1. Secondary to metastatic deposits within spinal column (most common)
  2. Secondary to Mechanical dysf (structural weakness bc other cancer)
  3. Primary CNS tumours
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4
Q

What are the cancers that most commonly cause MSCC? (5 things)

A
  1. Lung cancer
  2. Breast cancer
  3. Kidney cancer
  4. Prostate cancer
  5. Thyroid cancer
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5
Q

Where in the spine does MSCC usually happen?

A

1. Thoracic spine (60%)
2. Lumbar spine (30%)
3. Cervical spine (10%)

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6
Q

What are the CF of MSCC? (5 things)

A
  1. Back pain (95%)
  2. Weakness (symmetrical) (85%)
  3. Sensory symptoms
  4. Sphincter dysf
  5. Cauda equina syndrome (if CE part of spine affected)
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7
Q

When is the Back pain in MSCC worse?

A

@ coughing / straining

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8
Q

How does Sphincter dysf in MSCC present? (2 things)

A
  1. Urinary retention / incontinence
  2. Faecal incontinence
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9
Q

What is the GOLD standard investigation for MSCC Dx?

A

MRI

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10
Q

What is the use of MRI in MSCC Dx? (2 things)

A
  1. Accurate identification of compression site
  2. Can determine extent of disease
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11
Q

What is important about investigating sus MSCC?

A

It is an oncological emergency, needs rapid investigation + Mx

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12
Q

What are the General Initial Mx options for MSCC? (3 things)

A
  1. Analgesia
  2. VTE prophylaxis (bc cancer = VTE risk)
  3. Catheter (if any bladder dysf)
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13
Q

What are the VTE prophylaxis options for MSCC pt? (2 things)

A
  1. TED stockings
  2. Prophylactic LMWH
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14
Q

What is a more specific Initial Mx option for MSCC?

A

Dexamethasone (high dose)

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15
Q

What is the use of Dexamethasone in MSCC Mx?

A

Reduces oedema –> relieves compression

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16
Q

What are the Definitive Mx options for MSCC? (2 things)

A
  1. Surgery + Radiotherapy
  2. Radiotherapy (if can’t undergo surgery)
17
Q

What are the Surgical Mx options for MSCC? (3 things)

A
  1. Surgical decompression + Reconstruction
  2. Vertebroplasty (if can’t undergo full surgical decompression)
  3. Kyphoplasty (if can’t undergo full surgical decompression)