Management of Metastatic Spinal Cord Compression

Abstract

Cancer metastasis is a key event in tumor progression associated not only with mortality but also significant morbidity. Metastatic disease can promote end-organ dysfunction and even failure through mass effect compression of various vital organs including the spinal cord. In such cases, prompt medical attention is needed to restore neurological function, relieve pain, and prevent permanent damage. The three therapeutic approaches to managing metastatic spinal cord compression include corticosteroids, surgery, and radiation therapy. Although each may improve patients' symptoms, their combination has yielded the best outcome. In cancer patients with clinical suspicion of spinal cord compression, dexamethasone should be initiated followed by surgical decompression, when possible, and radiation. The latter becomes the preferred treatment in patients with inoperable disease.

Comparison of the postoperative pain change and spinal stenosis rate between percutaneous vertebroplasty combined with radiofrequency ablation and with 125I particle implantation in the treatment of metastatic spinal cord compression: A retrospective study

“… 3 Without treatment, the life expectancy of a patient with MSCC is approximately 1 month. 22 The primary tumor histology affected not only the time between diagnosis and MSCC, but also the postoperative survival time of patients. According to Loblaw et al., lung cancer causes patients to have the shortest lifespan following their first MSCC episode (1.5 months).…”

Evaluation of the AirgloveTM, An Air-Regulated Thermal-Venodilatory Device Facilitating the Cannulation of Patients With Difficult Venous Access

“…The use of corticosteroids is common in cancers as an anti-in ammatory and adjuvant in treatment 16 , to offset the effects of spinal cord compression in cancer metastasis 17 , to reduce the feeling of nausea and vomiting in cancer 18 , and sometimes to enhance appetite and wellbeing 19 . However, the use of corticosteroids is also well-known to cause systemic vasoconstriction via the adrenergic system 20 which could potentially decrease the chances of a successful cannulation.…”

Intrathecal betamethasone for cancer pain: A study of its analgesic efficacy and safety

“…ITB, administered once a week, produced long‐lasting analgesia without neurotoxic AEs. Of note, pain relief was achieved in most patients with vertebral column and/or surrounding nerve plexus metastases, the pain of which is difficult to treat, and the effect was found even when the pain was located in the upper half of the body, far from the site of the lumbar intrathecal injection. In contrast, ITB did not produce pain relief for sites far from the vertebral column such as rib and limb metastases, even in patients having both thoracic vertebral and rib metastases for which the innervation was from the same spinal segment.…”