Metastatic Spinal Cord Compression
Metastatic spinal cord compression is a medical emergency characterized by its potential for rapid deterioration of neurological function, often leading to significant impairments in quality of life. The most common mechanism is growth of a vertebral metastatic lesion with invasion of the epidural space and compression of the spinal cord. Patients commonly present with progressive pain and may later develop motor and sensory weakness, and autonomic dysfunction. The preferred imaging study is an MRI of the entire spine, which should be performed urgently. In patients without known malignancy, tissue diagnosis through biopsy as well as evaluation for primary site of disease and other metastases is necessary. Initial management includes steroids and analgesics. Treatment options include radiation and surgical decompression, and considerations include tissue type, an assessment of spinal stability, and performance status. Patients with metastatic spinal cord compression should be managed at centers capable of providing specialized treatment including radiation oncology and neurosurgery.
KeywordsMetastatic spinal cord compression Vertebral metastasis Intramedullary Corticosteroids Dexamethasone Magnetic resonance imaging Surgical decompression Stereotactic radiation Cancer Radiotherapy Tetraplegia Paraplegia
- 3.Bach F, Larsen B, Rhode K, Borgesen S, Gjerris F, Boge-Rasmussen T, Agerlin N, Rasmusson B, Stjernholm P, Sorensen P. Metastatic spinal cord compression. Occurrence, symptoms, clinical presentations and prognosis in 398 patients with spinal cord compression. Acta Neurochir. 1990;107(1–2):37–43.CrossRefPubMedGoogle Scholar
- 9.Elsberg C. Diseases of the spinal cord and membranes. Philadelphia: Saunders; 1916. p. 236–42.Google Scholar
- 10.George R, Jeba J, Ramkumar G, Chacko A, Tharyan P. Interventions for the treatment of metastatic extradural spinal cord compression in adults. Cochrane Database Syst Rev. 2015;4:1–30.Google Scholar
- 12.Graus F, Krol G, Foley K. Early diagnosis of spinal epidural metastases (SEM): correlation with clinical and radiographic findings. Proc Am Soc Clin Oncol. 1985;4(1):269.Google Scholar
- 23.Lo S, Ryu S, Chang E, Galanopoulos N, Jones J, Kim E, Kubicky C, Lee C, Rose P, Sahgal A, Sloan A, Teh B, Traughber B, Van Poznak C, Vassil A. ACR appropriateness criteria® metastatic epidural spinal cord compression and recurrent spinal metastasis. J Palliat Med. 2015;18(7):573–84.CrossRefPubMedGoogle Scholar