Spinal Cord Compression

Question 1

What cancers usually spread to the bone?

Answer 1

Breast
Bronchus
Myeloma
Renal cancer

Question 2

What is the cost common site in the bone of a metastasis?

Answer 2

Thoracic spine

Question 3

What are the presenting symptoms of cord compression?

Answer 3

Pain - along the dermatome, progressive, worse on moving, coughing, sneezing

Question 4

What are the findings on examination?

Answer 4

Spinal tenderness
UMN - hypertonia, hyper-reflexia, clonus and upper plantars
LOS
Urinary incontinence and reduced anal tone

Question 5

What is the GOLD standard investigation

Answer 5

MRI spine

Question 6

When is a CT indicated rather than an MRI for cord compression?

Answer 6

If the patient has a pacemaker of if not previously know to have a malignancy

Question 7

What specific blood test should you do?

Answer 7

Serum calcium

Question 8

What is the supportive management?

Answer 8

Keep the patient flat until the stability of the spine is determined 
Urinary catheter if retention 
Monitor bowel function - laxatives
Physiotherapy 
Daltepatin if bed-bound

Question 9

What is the medical management?

Answer 9

Dexamethasone - 8mg - reduces the oedema around the lesion
Give omeprazole with it
Monitor blood sugar

Question 10

What is the Sx options?

Answer 10

Surgical decompression with stabilisation followed by radiotherapy if fit

Question 11

Other Mx options?

Answer 11

If frail or not stable for surgery:
Radiotherapy - 4 fractions over 4 days
Chemotherapy - primary chemo is used if the primary tumour is highly chemosensitive eg germ cell tumours and lymphoma or there is no surgical/radiotherapy option