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A. Characteristicsnavigator

  1. Fairly common oncologic emergency
  2. Most often seen with metastatic disease
    1. Tumors that metastasize to bone
    2. Lymphomas may impinge through foramen in spinal column
  3. Occurrence in adults
    1. Lung
    2. Breast
    3. Prostate
    4. Ovarian
    5. Colon
    6. Lymphoma
  4. Occurrence in children
    1. Sarcoma
    2. Neuroblastoma
    3. Lymphoma
  5. Other causes of SCC
    1. Infection
    2. Hematoma
    3. Traumatic myelopathy: disk herniation, ligament rupture, hematoma
  6. Occurs in about 1 in 13,000 US cancer patients annually

B. Symptomsnavigator

  1. Pain: 85-95% on presentation; >95% on diagnosis (almost always back pain)
  2. Weakness: 5% on presentation; 75% on diagnosis
  3. Sensory Abnormalities
    1. Rare on presentation
    2. Following diagnosis, ~50% of cases show sensory abnormalities
  4. Autonomic Dysfunction
    1. Almost never on presentation; 57% on diagnosis
    2. Urinary and/or Fecal Incontinence

C. Diagnosis [2] navigator

  1. SCC is a neurologic / oncologic emergency
  2. Magnetic resonance imaging (MRI)
    1. Best tool for evaluation of suspected SCC
    2. For nontraumatic cases, entire spinal cord should be visualized without contrast
    3. Contrast enhanced MRI scanning should be carried out if no lesion is found initially
    4. if clinical concern is high, then glucocorticoids should be given prior to MRI evaluation
  3. For traumatic cases, computerized tomographic (CT) scan should also be done

D. Treatment [3] navigator

  1. High dose Glucocorticoid Therapy
    1. Initial therapy of choice in progressive cases
    2. Dexamethasone 10-100mg IV followed by 6-24 mg orally qid
    3. Taper over 10 days
    4. Usually for patients with impaired spinal cord function or high grade radiologic lesions
    5. Higher doses are probably preferred to maintain spinal function
    6. However, higher doses are not well tolerated
    7. if clinical concern is high, then glucocorticoids should be given prior to MRI evaluation
  2. Surgical Decompression
    1. Advocated for all radioresistant cancers
    2. Surgery with postoperative radiation was superior to radiation alone for all-comers with spinal cord compression [4]
    3. Therefore, combination surgery+postoperative radiation should be considered in all cases
  3. Radiation Therapy
    1. Indicated for prostate or breast cancers, myeloma or lymphoma
    2. Other tumors may be radioresistant
  4. Pain Management is critical, along with initial glucocorticoids
  5. Supportive Care
    1. Rehabilition improves both impaired function and associated depression
    2. Patients often depressed, and this should also be treated aggressively

References navigator

  1. Abrahm JL, Banffy MB, Harris MB. 2008. 299(8):937 abstract
  2. Quint DJ. 2000. JAMA. 283(7):853 abstract
  3. Abrahm JL et al. 1999. Ann Intern Med. 131(1):37 abstract
  4. Patchell RA, Tibbs PA, Regine WF, et al. 2005. 366(9486):643 abstract