Epidural spinal cord compression

Abstract

Epidural spinal cord compression is a neurologic emergency requiring immediate attention. The therapy instituted depends on several factors, including the patient's condition at the time of presentation, the nature of the underlying malignancy, the extent of systemic disease burden, and patient prognosis. The most essential aspect of treatment is the establishment of the diagnosis. If one suspects malignant cord compression an emergency, magnetic resonance imaging of the entire spinal axis is indicated. If magnetic resonance imaging is unavailable, post-myelographic computed tomography is an alternative. However, treatment should not be delayed until imaging is performed, particularly if neurologic deficits are present. Pain should be adequately addressed and opioids administered if necessary. Steroids should be given. If significant neurologic deficits are present, a high-dose corticosteroid bolus, followed by standing doses, should be given. However, if pain is the predominant symptom, steroids can be withheld pending immediate imaging or lower doses can be given without a bolus. Neurosurgical consultation should be obtained, and surgery should be considered if the patient's condition permits. This is particularly true if spinal instability or significant kyphosis is present or compression is secondary to bony fragments. Other indications include patients with limited systemic disease burden in whom better survival is predicted and possibly those with radioresistant tumors. The type of surgery performed should be tailored to the distribution of disease within the spine and accessibility through anterior body cavities. Radiation therapy, an effective noninvasive treatment that can be delivered quickly and safely, is an appropriate option as well. This is particularly true in radio-responsive tumors, such as myeloma and lymphoma, in which surgery may be avoided entirely. Chemotherapy may play a role as adjuvant therapy in some tumors.

Malignant spinal cord compression in cancer patients may be mimicked by a primary spinal cord tumour

“…2000; Mathur et al . 2000; Cavaliere & Schiff 2004; Klimo & Schmidt 2004). Lung and breast carcinoma are the most common primary sites, followed by malignant melanoma, renal cell carcinoma, colon cancer and lymphoma (Koeller et al .…”

Nicht traumatische Rückenmarkskompression: MRT-Prinzipien für die Notaufnahme

“…Bei rund 20 % der Patienten stellen Wirbelsäulenmetastasen die Erstmanifestation der malignen Erkrankung dar [18,19]. Spinale Metastasen mit epiduraler Rückenmarkskompression kommen signifikant häufiger vor als intradurale oder intramedulläre Metastasen und machen 98 % der Wirbelsäulenmetastasen aus [20]. Prostata-, Bronchial-und Mammakarzinome sowie Nierenzellkarzinome und Lymphome streuen am häufigsten in die Wirbelsäule und breiten sich in den Epiduralraum aus.…”