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Occurs in 5-10% of pts with cancer; epidural tumor may be the initial manifestation of malignancy. Most neoplasms are epidural in origin and result from metastases to the adjacent spinal bones. Almost any malignant tumor can metastasize to the spinal column with lung, breast, prostate, kidney, lymphoma, and plasma cell dyscrasia being particularly frequent. The thoracic cord is most commonly involved; exceptions include prostate and ovarian tumors, which preferentially involve the lumbar and sacral segments from spread through veins in the anterior epidural space. Urgent MRI is indicated when the diagnosis is suspected; up to 40% of pts with neoplastic cord compression at one level are found to have asymptomatic epidural disease elsewhere. Plain radiographs will miss 15-20% of metastatic vertebral lesions.

Treatment: Neoplastic Spinal Cord Compression

  • Glucocorticoids to reduce edema (dexamethasone, up to 40 mg daily) can be administered before the imaging study if the clinical suspicion is high, and continued at a lower dose until radiotherapy (generally 3000 cGy administered in 15 daily fractions) and/or surgical decompression is completed.
  • Early surgery, either decompression by laminectomy or vertebral body resection, followed by radiotherapy is more effective than radiotherapy alone for pts with a single area of spinal cord compression by extradural tumor.
  • Time is of the essence; fixed motor deficits (paraplegia or quadriplegia) once established for >12 h do not usually improve, and beyond 48 h the prognosis for substantial motor recovery is poor.
  • Biopsy is needed if there is no history of underlying malignancy; a simple systemic workup including chest imaging, mammography, measurement of prostate-specific antigen (PSA), and abdominal CT usually reveals the diagnosis.

Outline

Section 2. Medical Emergencies