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Malignant Spinal Cord Compression

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Oncologic Emergency Medicine
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Abstract

Malignant spinal cord compression is a dreaded consequence of advanced cancer. Patients with this condition have an average life expectancy of 3–6 months. Diagnosis is dependent upon a high index of suspicion, thorough physical exam, and advanced imaging. A multidisciplinary approach to treatment is required to ensure optimal outcome. This chapter will explore the epidemiology and risk factors for metastatic spinal cord compression. We will discuss the pathophysiology of the condition and clinical presentation. Finally, we will review management of the condition and its implications for planning future care.

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References

  1. Deyo RA, Rainville J, Kent DL. What can the history and physical examination tell us about low back pain? JAMA. 1992;268(6):760–5.

    Article  CAS  PubMed  Google Scholar 

  2. Loblaw DA, Perry J, Chambers A, Laperriere NJ. Systematic review of the diagnosis and management of malignant extradural spinal cord compression: the Cancer Care Ontario Practice Guidelines Initiative’s Neuro-Oncology Disease Site Group. J Clin Oncol. 2005;23(9):2028–37.

    Article  PubMed  Google Scholar 

  3. Byrne TN. Spinal cord compression from epidural metastases. N Engl J Med. 1992;327(9):614–9.

    Article  CAS  PubMed  Google Scholar 

  4. Loblaw DA, Laperriere NJ, Mackillop WJ. A population-based study of malignant spinal cord compression in Ontario. Clin Oncol (R Coll Radiol). 2003;15(4):211–7.

    Article  CAS  Google Scholar 

  5. Mak RH, Lee LK, Mak KS, Wang S, Pile-Spellman J, Abrahm J, et al. Incidence and treatment patterns in hospitalizations for malignant spinal cord compression in the United States, 1998-2006. Int J Radiat Oncol Biol Phys. 2011;80(3):824–31.

    Article  PubMed  Google Scholar 

  6. Constans JP, de Divitiis E, Donzelli R, Spaziante R, Meder JF, Haye C. Spinal metastases with neurological manifestations. Review of 600 cases. J Neurosurg. 1983;59(1):111–8.

    Article  CAS  PubMed  Google Scholar 

  7. Schiff D, O’Neill BP, Suman VJ. Spinal epidural metastasis as the initial manifestation of malignancy: clinical features and diagnostic approach. Neurology. 1997;49(2):452–6.

    Article  CAS  PubMed  Google Scholar 

  8. Levack P, Graham J, Collie D, Grant R, Kidd J, Kunkler I, et al. Don’t wait for a sensory level—listen to the symptoms: a prospective audit of the delays in diagnosis of malignant cord compression. Clin Oncol (R Coll Radiol). 2002;14(6):472–80.

    Article  CAS  Google Scholar 

  9. Talcott JA, Stomper PC, Drislane FW, Wen PY, Block CC, Humphrey CC, et al. Assessing suspected spinal cord compression: a multidisciplinary outcomes analysis of 342 episodes. Support Care Cancer. 1999;7(1):31–8.

    Article  CAS  PubMed  Google Scholar 

  10. Abrams HL, Spiro R, Goldstein N. Metastases in carcinoma; analysis of 1000 autopsied cases. Cancer. 1950;3(1):74–85.

    Article  CAS  PubMed  Google Scholar 

  11. Wong DA, Fornasier VL, MacNab I. Spinal metastases: the obvious, the occult, and the impostors. Spine (Phila Pa 1976). 1990;15(1):1–4.

    Article  CAS  Google Scholar 

  12. Savage P, Sharkey R, Kua T, Schofield L, Richardson D, Panchmiatia N, et al. Malignant spinal cord compression: NICE guidance, improvements and challenges. Q J Med. 2014;107:277–82.

    Article  CAS  Google Scholar 

  13. Schiff D. Spinal cord compression. Neurol Clin. 2003;21(1):67–86. viii.

    Article  PubMed  Google Scholar 

  14. Schiff D, O’Neill BP, Wang CH, O’Fallon JR. Neuroimaging and treatment implications of patients with multiple epidural spinal metastases. Cancer. 1998;83(8):1593–601.

    Article  CAS  PubMed  Google Scholar 

  15. Husband DJ, Grant KA, Romaniuk CS. MRI in the diagnosis and treatment of suspected malignant spinal cord compression. Br J Radiol. 2001;74(877):15–23.

    Article  CAS  PubMed  Google Scholar 

  16. Lu C, Gonzalez RG, Jolesz FA, Wen PY, Talcott JA. Suspected spinal cord compression in cancer patients: a multidisciplinary risk assessment. J Support Oncol. 2005;3(4):305–12.

    PubMed  Google Scholar 

  17. Arguello F, Baggs RB, Duerst RE, Johnstone L, McQueen K, Frantz CN. Pathogenesis of vertebral metastasis and epidural spinal cord compression. Cancer. 1990;65(1):98–106.

    Article  CAS  PubMed  Google Scholar 

  18. Prasad D, Schiff D. Malignant spinal-cord compression. Lancet Oncol. 2005;6(1):15–24.

    Article  PubMed  Google Scholar 

  19. Helweg-Larsen S, Laursen H. Clinical and autopsy findings in spinal cord compression due to metastatic disease. Eur J Neurol. 1998;5(6):587–92.

    Article  PubMed  Google Scholar 

  20. Bach F, Larsen BH, Rohde K, Borgesen SE, Gjerris F, Boge-Rasmussen T, et al. Metastatic spinal cord compression. Occurrence, symptoms, clinical presentations and prognosis in 398 patients with spinal cord compression. Acta Neurochir (Wien). 1990;107(1-2):37–43.

    Article  CAS  Google Scholar 

  21. Gilbert RW, Kim JH, Posner JB. Epidural spinal cord compression from metastatic tumor: diagnosis and treatment. Ann Neurol. 1978;3(1):40–51. 21.

    Article  CAS  PubMed  Google Scholar 

  22. Abrahm JL, Banffy MB, Harris MB. Spinal cord compression in patients with advanced metastatic cancer: “All I care about is walking and living my life.”. JAMA. 2008;299(8):937–46.

    Article  CAS  PubMed  Google Scholar 

  23. Husband DJ. Malignant spinal cord compression: prospective study of delays in referral and treatment. BMJ. 1998;317(7150):18–21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. National Collaborating Centre for Cancer (UK). Metastatic Spinal Cord Compression. Diagnosis and management of patients at risk of or with metastatic spinal cord compression. Cardiff (UK): National Collaborating Centre for Cancer (UK); 2008 Nov. (NICE Clinical Guidelines, No. 75.) Available from: http://www.ncbi.nlm.gov/books/NBK55007/.

  25. Shiue K, Sahgal A, Chow E, Lutz ST, Chang EL, Mayr NA, et al. Management of metastatic spinal cord compression. Expert Rev Anticancer Ther. 2010;10(5):697–708.

    Article  PubMed  Google Scholar 

  26. Hammack JE. Spinal cord disease in patients with cancer. Continuum (Minneap MN). 2012;18(2):312–27.

    Google Scholar 

  27. Helweg-Larsen S. Clinical outcome in metastatic spinal cord compression. A prospective study of 153 patients. Acta Neurol Scand. 1996;94(4):269–75.

    Article  CAS  PubMed  Google Scholar 

  28. Rades D, Fehlauer F, Schulte R, Veninga T, Stalpers LJ, Basic H, et al. Prognostic factors for local control and survival after radiotherapy of metastatic spinal cord compression. J Clin Oncol. 2006;24(21):3388–93.

    Article  PubMed  Google Scholar 

  29. McLinton A, Hutchison C. Malignant spinal cord compression: a retrospective audit of clinical practice at a UK regional cancer centre. Br J Cancer. 2006;94(4):486–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Dugas AF, Lucas JM, Edlow JA. Diagnosis of spinal cord compression in nontrauma patients in the emergency department. Acad Emerg Med. 2011;18(7):719–25.

    Article  PubMed  Google Scholar 

  31. Ditunno Jr JF, Young W, Donovan WH, Creasey G. American Spinal Surgery Association. The international standards booklet for neurological and functional classification of spinal cord injury. American Spinal Injury Association. Paraplegia. 1994;32(2):70–80.

    Article  PubMed  Google Scholar 

  32. Frankel HL, Hancock DO, Hyslop G, Melzak J, Michelis LS, Unger GH, et al. The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. I. Paraplegia. 1969;7(3):179–92.

    Article  CAS  PubMed  Google Scholar 

  33. Portenoy RK, Galer BS, Salamon O, Freilich M, Finkel JE, Milstein D, et al. Identification of epidural neoplasm. Radiography and bone scintigraphy in the symptomatic and asymptomatic spine. Cancer. 1989;64(11):2207–13.

    Article  CAS  PubMed  Google Scholar 

  34. Carmody RF, Yang PJ, Seeley GW, Seeger JF, Unger EC, Johnson JE. Spinal cord compression due to metastatic disease: diagnosis with MR imaging versus myelography. Radiology. 1989;173(1):225–9.

    Article  CAS  PubMed  Google Scholar 

  35. O’Rourke T, George C, Redmond J, Davidson H, Cornett P, Fill WL, et al. Spinal computed tomography and computed tomographic metrizamide myelography in the early diagnosis of metastatic disease. J Clin Oncol. 1986;4(4):576–83.

    PubMed  Google Scholar 

  36. Bilsky MH, Laufer I, Fourney DR, Groff M, SChmidt MH, Varga PP, et al. Reliability analysis of the epidural spinal cord compression scale. J Neurosurg Spine. 2010;13(3):324–8.

    Article  PubMed  Google Scholar 

  37. Prewett S, Venkitaraman R. Metastatic spinal cord compression: Review of the evidence for a radiotherapy dose fractionation schedule. Clin Oncol. 2010;22:222–30.

    Article  CAS  Google Scholar 

  38. van den Hout WB, van der Linden YM, Steenland E, Wiggenraad RGJ, Kievit J, de Heas H, et al. Single- versus multiple-fraction radiotherapy in patients with painful bone metastases: cost-utility analysis based on a randomized trial. J Natl Cancer Inst. 2003;95(3):222–9.

    Article  PubMed  Google Scholar 

  39. Rades D, Abrahm JL. The role of radiotherapy for metastatic epidural spinal cord compression. Nat Rev Clin Oncol. 2010;7(10):590–8.

    Article  PubMed  Google Scholar 

  40. Mancosu P, Navarria P, Bignardi M, Cozzi L, Fogliata A, Lattuada P, et al. Re-irradiation of metastatic spinal cord compression: a feasibility study by volumetric-modulated arc radiotherapy for in-field recurrence creating a dosimetric hole in the central canal. Radiother Oncol. 2010;94:67–70.

    Article  PubMed  Google Scholar 

  41. Steenland E, Leer JW, van Houwelingen H, Post WJ, van den Hout WB, Kievit J, et al. The effect of a single fraction compared to multiple fractions on painful bone metastases: a global analysis of the Dutch Bone Metastasis Study. Radiother Oncol. 1999;52(2):101–9.

    Article  CAS  PubMed  Google Scholar 

  42. Lange M, Veninga T, Stalpers LJ, Bajrovic A, Adamietz IA, et al. Final results of a prospective study comparing the local control of short course and long course radiotherapy for metastatic spinal cord compression. Int J Radiat Oncol Biol Phys. 2011;79(2):524–30.

    Article  PubMed  Google Scholar 

  43. Maranzano E, Latini P, Beneventi S, et al. Radiotherapy without steroids in selected metastatic spinal cord compression. Am J Clin Oncol. 1996;19(2):179–83.

    Article  CAS  PubMed  Google Scholar 

  44. Sundaresan N, Sachdev VP, Holland JF, et al. Surgical treatment of spinal cord compression from epidural metastasis. J Clin Oncol. 1995;13(9):2330–5.

    CAS  PubMed  Google Scholar 

  45. Patchell RA, Tibbs PA, Regine WF, Payne R, Sarls S, Kryscio RJ, et al. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet. 2005;366(9486):643–8.

    Article  PubMed  Google Scholar 

  46. Akram H, Allibone J. Spinal surgery for palliation in malignant spinal cord compression. Clin Oncol (R Coll Radiol). 2010;22(9):792–800.

    Article  CAS  Google Scholar 

  47. Loblaw DA, Mitera G, Ford M, Laperriere NJ. A 2011 updated systematic review and clinical practice guideline for the management of malignant extradural spinal cord compression. Int J Radiat Oncol Biol Phys. 2012;84(2):312–7.

    Article  PubMed  Google Scholar 

  48. Sorensen S, Helweg-Larsen S, Mouridsen H, Hansen HH. Effect of high-dose dexamethasone in carcinomatous metastatic spinal cord compression treated with radiotherapy: a randomised trial. Eur J Cancer. 1994;30A(1):22–7.

    Article  CAS  PubMed  Google Scholar 

  49. Heimdal K, Hirschberg H, Slettebo H, Watne K, Nome O. High incidence of serious side effects of high-dose dexamethasone treatment in patients with epidural spinal cord compression. J Neurooncol. 1992;12(2):141–4.

    Article  CAS  PubMed  Google Scholar 

  50. L’Esperance S, Vincent F, Gaudreault M, Ouellet JA, Li M, Tosikyan A, et al. Treatment of metastatic spinal cord compression: CEPO review and clinical recommendations. Currr Oncol. 2012;19(6):e478–90.

    Google Scholar 

  51. Posner JB, Howieson J, Cvitkovic E. “Disappearing” spinal cord compression: oncolytic effect of glucocorticoids (and other chemotherapeutic agents) on epidural metastases. Ann Neurol. 1977;2(5):409–13.

    Article  CAS  PubMed  Google Scholar 

  52. Kan E, Levi I, Benharroch D. Alterations in the primary diagnosis of lymphomas pretreated with corticosteroid agents. Leuk Lymphoma. 2011;52(3):425–8.

    Article  PubMed  Google Scholar 

  53. Borenstein SH, Gerstle T, Malkin D, Thorner P, Filler RM. The effects of prebiopsy corticosteroid treatment on the diagnosis of mediastinal lymphoma. J Pediatr Surg. 2000;35(6):973–6.

    Article  CAS  PubMed  Google Scholar 

  54. Curtis RE, Freedman DM, Ron E, Ries LAG, Hacker DG, Edwards BK, et al. editors. New malignancies among cancer survivors: SEER cancer registries, 1973–2000 (NIH Publ. No. 05-5302). Bethesda, MD: National Cancer Institute; 2006.

    Google Scholar 

  55. Travis L. The epidemiology of second primary cancers. Cancer Epidemiol Biomarkers Prev. 2006;15:20–2026.

    Article  Google Scholar 

  56. Rades D, Hueppe M, Schild SE. A score to identify patients with metastatic spinal cord compression who may be candidates for best supportive care. Cancer. 2013;119(4):897–903.

    Article  PubMed  Google Scholar 

  57. Guo Y, Palmer JL, Bianty J, Konzen B, Shin K, Bruera E. Advance directives and do-not-resuscitate orders in patients with cancer with metastatic spinal cord compression: advanced care planning implications. J Palliat Med. 2010;13(5):513–7.

    Article  PubMed  PubMed Central  Google Scholar 

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Correspondence to Jayne M. Viets-Upchurch MD .

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Viets-Upchurch, J.M. (2016). Malignant Spinal Cord Compression. In: Todd, K., Thomas, Jr., C. (eds) Oncologic Emergency Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-26387-8_13

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  • DOI: https://doi.org/10.1007/978-3-319-26387-8_13

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