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Spinal Cord Compression

Spinal cord compression (SCC) is a serious neurological problem. It occurs when a spinal cord tumour or metastatic tumour grows in the spine and destroys the bony vertebral body that surrounds the cord, or wraps around the spinal cord and its nerve roots. If the vertebral body collapses, it puts pressure on and compresses the spinal cord. Compression can disrupt the spinal cord's blood supply and affect its function leading to:

  • swelling of the cord
  • cord injury
  • long-term neurological problems

Location

The most common area for spinal cord metastases are the:

  • middle part of the back or chest (thoracic spine) – 70%
    • there are more thoracic vertebrae than vertebrae in the upper or lower back
  • lower back (lumbar spine) – 20%
  • upper back or neck area (cervical spine) – 10%

Causes

Spinal cord compression is most often associated with cancers that tend to spread (metastasize) to the bone:

  • breast
  • lung
  • prostate
  • kidney
  • multiple myeloma
  • lymphoma

 

The vertebrae are the most common site of bone metastases.

Symptoms

The spinal cord may become compressed suddenly and produce symptoms in minutes or hours, or more slowly to produce symptoms over many weeks or months. Symptoms may be quite mild if compression to the spinal cord is small. As the compression increases, the symptoms may worsen. Symptoms are usually related to the location of the lesion and amount of compression.

Back pain

  • most common symptom
  • caused by irritation of the nerve roots by the tumour
  • usually localized at first
  • may be described as belt-like pain at the level of the compression
  • can move or radiate from one area to another
  • may be dull, aching and constant
  • may be persistent and progressive
  • becomes worse when lying down, coughing, sneezing or moving
  • can be present for a few days or months
  • can be a sign of an impending cord compression

Neurological symptoms

  • muscle weakness
    • described as heaviness or stiffness of limbs
  • change in the way a person walks (gait)
  • change in or loss of sensation
  • numbness and tingling
  • change in bowel or urinary habits such as constipation or inability to urinate
  • loss of bowel or bladder control (incontinence)

 

If untreated, spinal cord compression may go on to cause serious neurological problems such as paralysis. Less than ¼ of people who are paralyzed at the time they are diagnosed with SCC, will regain their ability to walk after treatment.

Diagnosis

Tests that help diagnose SCC include:

  • physical and neurological examination
    • the doctor can determine which part of the spinal cord is affected based on the symptoms and physical examination results
  • imaging tests
    • x-rays
    • magnetic resonance imaging (MRI) of the spine
    • myelogram of the spine, with contrast medium inserted around the spinal cord and computed tomography (CT) scan if an MRI cannot be done

Treatment

Early diagnosis and treatment may prevent permanent damage to the spinal cord.

Goals of treatment are:

  • to reduce or control pain
  • to relieve compression
  • to reduce or improve neurological symptoms
  • to stabilize the spine
  • to decrease the size of the tumour and control tumour growth

Treatments may include:

Steroids

  • to quickly decrease swelling of the spinal cord and relieve pain
  • high doses of corticosteroids (e.g. dexamethasone) are given intravenously
  • doses are gradually tapered and then discontinued

Radiation therapy

  • to decrease tumour size
  • used for tumours that are responsive to radiation therapy such as lymphoma or multiple myeloma
  • the number or length of radiation treatments depends on the type of cancer causing SCC and how the person responds to treatment

Surgery

  • to stabilize the spine and relieve compression on the cord and nerve roots (laminectomy or vertebral body resection)
    • laminectomy removes a portion of the bone of the vertebra
    • vertebral body resection removes bone fragments and diseased bone
      • special materials or bone grafts are used to reconstruct the bone and steel pins or rods may be used to further stabilize the spine
  • to remove as much of the tumour as possible
  • used if the tumour does not respond to radiation therapy or if the person has had prior radiation therapy
  • if severe neurological deficits are present before surgery, then the person will rarely benefit from surgery

Chemotherapy

  • mainly used for cancers that are sensitive to chemotherapy (chemosensitive) such as Hodgkin's disease
  • bisphosphonates – drugs used to treat complications of bone metastases such asloss of bone substance – may be used to delay the onset and frequency of bone-related events such as fractures, bone pain or SCC

 

Sometimes a combination of therapies are used. Radiation therapy may be given after surgery to achieve better results.

 

The doctor may order physical therapy or other rehabilitation measures after treatment for SCC in order to maintain and improve a person's mobility and function.

References

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