Spinal Cord Compression Flashcards
Is spinal cord compression a medical emergency?
Yes
What is required with spinal cord emergency?
Swift diagnosis and treatment
Why is it important that spinal cord compression receives swift diagnosis and treatment?
To prevent long-term disability due to irreversible spinal cord injury
What is metastatic spinal cord compression?
Compression by direct pressure and/or induction of vertebral collapse or instability by metastatic spread or direct extension of malignancy that threatens to cause neurological disability
What might cause malignant spinal cord compression?
- Extradural spread from vertebral body metastasis
- Direct metastasis
- Vertebral crush fracture
What cancers most often metastasise to bone and cause spinal cord compression?
- Breast
- Kidney
- Thyroid
- Prostate
- Lung
When are most spinal metastases diagnosed?
Most are diagnosed following the diagnosis of the primary cancer
In what % of cases are spinal metastases the first manifestation of an unknown tumour?
10%
How can early detection of spinal cord compression be achieved?
You should inform patients at high risk of metastases of the symptoms of spinal cord compression, and advise them of what to do should they develop these symptoms
What symptoms suggest possible spinal metastases?
- Pain in thoracic or cervical spine
- Severe unremitting or progressive lumbar spine pain
- Spinal pain aggravated by straining
- Noctural spinal pain preventing sleep
- Localised spinal tenderness
What symptoms suggest spinal cord compression?
- Radicular pain
- Limb weakness
- Difficulty in walking
- Sensory loss, or bladder and bowel dysfunction
- Neurological signs of spinal cord or cauda equina compression
What investigation is done in spinal cord compression?
MRI imaging of whole spine
What is the purpose of MRI imaging of the whole spine in spinal cord compression?
So definitive treatment can be planned
How soon should MRI imaging of the whole spine be performed if clinical features suggest spinal metastasis?
Within 1 week
How soon should MRI imaging of the whole spine be performed if clinical features suggest spinal cord compression?
Within 24 hours, or sooner (including out of hours) if emergency treatment is needed
When should management be started for spinal cord compression?
As soon as possible after diagnosis
What is the aim of starting treatment as soon as possible after diagnosis in spinal cord compression?
- Minimising permanent damage to the spinal cord
- Reduce pain
Why might treatment for spinal cord compression reduce pain?
If the treatment shrinks the tumour and therefore relieves the pressure on the nerves and spinal cord
What factors will the treatment for spinal cord compression depend on?
- Type of cancer
- Area of spine affected
- General fitness
What are the treatment options for spinal cord compression?
- Steroids
- Radiotherapy
- Chemotherapy
- Surgery
- Hormonal therapy
- Drugs that strengthen bones
How do steroids work in spinal cord compression?
They help reduce pressure and swelling around the spinal cord
Who should be given steroids in spinal cord compression?
All patients with spinal cord compression unless contraindicated
Give an example of a contraindication to steroids in spinal cord compression
Significant suspicion of lymphoma
What steroid is given in spinal cord compression?
Dexamethasone
What dose of dexamethasone should be given in spinal cord compression?
16mg loading dose, followed by short course of 16mg daily while treatment is being planned
When should the loading dose of dexamethasone be given in spinal cord compression?
As soon as possible after assessment
What should happen to the dose of steroids after surgery or the start of radiotherapy in spinal cord compression?
It should be gradually reduced over 5-7 days and stopped
What should be done to the dose of steroids if the neurological function deteriorates at any time in spinal cord compression?
Reconsider the dose
What is the most common treatment for spinal cord compression?
Radiotherapy
Is radiotherapy used on its own or in conjunction with other treatments in spinal cord compression?
Can be used on its own, or alongside other treatments such as surgery
What kind of radiotherapy is used for spinal cord compression?
External radiotherapy
What course of radiotherapy is given in spinal cord compression?
Usually given as a short course of treatment, ranging from 1 single treatment to one treatment a day for 1-3 weeks, or longer for some types of cancer
When should radiotherapy for spinal cord compression be started?
As soon as possible after diagnosis
is surgery available for everyone with spinal cord compression?
No, it is only available for a small number of people
What does the availability of surgery in spinal cord compression depend on?
- Type of cancer
- Area of spine affected
- How stable the spine is
What is the aim of surgery in spinal cord compression?
Remove as much of the tumour as possible, and relieve pressure on the spinal cord and nerves
May also involve removing several parts of the vertebrae
What care needs to be taken with surgery for spinal cord compression?
Not to weaken the spine
What types of surgery are used in the management of spinal cord compression?
- Stabilisation and debulking of the tumour
- Decompression laminectomy
What is a decompression laminectomy?
Where a section of bone is removed from one of the vertebrae
How can the spine be further stabilised in spinal cord compression?
Using metal rods, screws, or bone grafts
When might adjuvant radiotherapy be given in spinal cord compression?
If the tumour cannot be completely removed, or if there is recurrence
When is chemotherapy used to treat spinal cord compression?
When it is caused by tumours that are very sensitive to chemotherapy, e.g. lymphoma, testicular cancer
What is hormonal therapy often used in combination with in spinal cord compression?
Chemotherapy
When is hormonal therapy used in spinal cord compression?
For certain cancers such as breast cancer and prostate cancer
Give two examples of drugs that strengthen the bones
- Bisphosphonates
- Denosumab
