Spinal cord compression - degenration, tumour

Question 1

Three most common causes of neoplastic spinal cord compression original site cancers

Answer 1

Breast
Lung
PROSTATE

Question 2

Primary spinal tumours -. compression

Answer 2

Myeloma - plasma cells - weakensbone
Lymphoma

Question 3

Features of spinal cord compression

Answer 3

Back pain - earliest and most common - worse on lying down and coughing
Lower limb weakness
Sensory changes - loss and numbness
Neurological signs - depends on level of lesion

Question 4

Neuro signs depedning on level of spinal cord compression

Answer 4

Above L1 - UMN signs in legs and perianal numbness
Below L1 -> LMN lesions
Tendon reflexes increased bleow and absent at level of lesion

Question 5

Investigations for spinal cord compression

Answer 5

Whole MRI spine within 24 hours
CT myelography

Question 6

Blood tests in spinal cord compression

Answer 6

FBC
Renal function
LFTs
Bone profile - elevated calcium
Clotting studies

Question 7

Further investigations in cancer sus spinal cord compression

Answer 7

Full history and examination.
Ask about constitutional symptoms.
Examination should include checking for lymphadenopathy, breast examination and digital rectal examination.
Further investigation will be guided by the results of the history and examination but often include
Tumour markers e.g. PSA in men, CA125 in women, LDH
Myeloma screen
Chest x-ray
CT of the chest, abdomen and pelvis.

Question 8

Causes of spinal cord compression

Answer 8

Prolapsed IV disc
Osteoporotic vertebral fracture
Epidural/subrudal haematoma
Epidural/subdrual abscess, vertberal osteomyelitis+discitis (staph aureus)
Trauma
Vertebral subluxation

Question 9

Management of spinal cord compression - general

Answer 9

Mobilisation
Corticosteroids - dexamethasone
Analgesia
Sphincter function incontinence assessment VTE prophylaxis

Question 10

Management of spinal cord compression - definitive treatment

Answer 10

Surgical management
Tokuhashi scoring system
Radiotherapy

Question 11

what offer is patient has a severe neurological impairment (i.e. paraplegia or tetraplegia) for greater than 24 hours,

Answer 11

spinal stabilisation surgery should only be offered for pain relief.

Question 12

Physical complications

Answer 12

Patients may lose their ability to walk and therefore their care needs will change.
Bladder and bowel incontinence as described above.
Pressure ulcers, infection and DVT risk related to immobility
Related to surgery and radiotherapy treatment.
Surgical complications include wound complications but also any anaesthetic complications such as postoperative atelectasis.
Radiotherapy complications include skin irritation/blistering.

Question 13

Tokuhashi scoring system

Answer 13

Overall health
The number of non-vertebral bone metastases
The number of vertebral metastases
The number of metastases to other internal organs
Primary cancer
Neurological deficit

Question 14

Tokuhashi score and preognosis

Answer 14

Fewer than 6 months
6 months to 1 year
Greater than 1 year