Neoplastic spinal cord compression

Question 1

What is neoplastic spinal cord compression?

Answer 1

Spinal cord compression is an oncological emergency and affects up to 5% of cancer patients. Extradural compression accounts for the majority of cases, usually due to vertebral body metastases. It is more common in patients with lung, breast and prostate cancer

Question 2

Features of spinal cord compression?

Answer 2

back pain
- the earliest and most common symptom
- may be worse on lying down and coughing

lower limb weakness

sensory changes: sensory loss and numbness

neurological signs depend on the level of the lesion. Lesions above L1 usually result in upper motor neuron signs in the legs and a sensory level. Lesions below L1 usually cause lower motor neuron signs in the legs and perianal numbness. Tendon reflexes tend to be increased below the level of the lesion and absent at the level of the lesion

Question 3

Investigations for spinal cord compression?

Answer 3

urgent MRI: the 2019 NICE guidelines recommend a whole MRI spine within 24 hours of presentation

Question 4

Management?

Answer 4

high-dose oral dexamethasone
urgent oncological assessment for consideration of radiotherapy or surgery