Neoplastic spinal cord compression Flashcards
What is spinal cord compression?
Spinal cord compression is an oncological emergency affecting up to 5% of cancer patients.
What is the most common cause of spinal cord compression?
Extradural compression, usually due to vertebral body metastases.
Which cancers are most commonly associated with spinal cord compression?
Lung, breast, and prostate cancer.
What is the earliest and most common symptom of spinal cord compression?
Back pain.
How can back pain be affected by position?
It may be worse when lying down and coughing.
What are some neurological features of spinal cord compression?
Lower limb weakness and sensory changes such as sensory loss and numbness.
What neurological signs are associated with lesions above L1?
Upper motor neuron signs in the legs and a sensory level.
What neurological signs are associated with lesions below L1?
Lower motor neuron signs in the legs and perianal numbness.
What happens to tendon reflexes below the level of the lesion?
Tendon reflexes tend to be increased below the level of the lesion and absent at the level of the lesion.
What is the recommended investigation for suspected spinal cord compression?
Urgent MRI.
What do the 2019 NICE guidelines recommend for MRI timing?
A whole MRI spine within 24 hours of presentation.
What is the first line management for spinal cord compression?
High-dose oral dexamethasone.
What type of assessment is needed for further management of spinal cord compression?
Urgent oncological assessment for consideration of radiotherapy or surgery.
