from: neurology
spinal cord compression
(Continuum 2021;27:163)
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Acute: flaccid paraparesis and absent reflexes (“spinal shock”)
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Subacute–chronic: spastic paraparesis and hyperreflexia (upgoing toes ± ankle clonus)
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Posterior column dysfunction in legs (loss of vibratory and/or proprioceptive sense)
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Sensory loss below level of lesion (truncal level ↑ bilateral leg sx is clue for cord process)
Evaluation and treatment of spinal cord compression
Info
spinal cord compression
Clinical manifestations (Lancet Neuro 2008;7:459) • Metastases located in vertebral body extend and cause epidural spinal cord compression • Prostate, breast, and lung cancers are most common, followed by RCC, NHL, myeloma • Site of involvement: thoracic (60%), lumbar (25%), cervical (15%) • Signs and symptoms: pain (>95%, precedes neuro Δs), weakness, autonomic dysfunction (urinary retention, ↓ anal sphincter tone), sensory loss Diagnostic evaluation • Always take back pain in Pts w/ cancer seriously. Urgent whole-spine MRI; CT if unable. • Do not wait for neurologic signs to develop before initiating evaluation b/c duration & severity of neuro dysfunction before treatment are best predictors of neurologic outcome Treatment (NEJM 2017;376:1358) • Dexamethasone (10 mg IV × 1 STAT, then 4 mg IV or PO q6h) initiate immediately while awaiting imaging if back pain + neurologic deficits • Emergent RT or surgical decompression if confirmed compression/neuro deficits • Surgery + RT superior to RT alone for neuro recovery in solid tumors (Lancet 2005;366:643) • If pathologic fracture causing compression → surgery; if not surgical candidate → RT