Spinal cord compression
Spinal cord compression occurs when a tumor invades the spinal canal or exerts pressure on the spinal cord and nerve roots, often due to metastasis from other cancers. It is a serious condition that can affect motor, sensory, and vital functions, as the spinal cord plays a critical role in bodily operations such as walking and breathing. The most significant risk factors include advanced-stage tumors, particularly from cancers like breast, lung, prostate, bone, and renal origins, which are prone to metastasizing to the spinal area.
Symptoms typically start with localized back pain, which can evolve into more severe issues such as muscle weakness, numbness, loss of bladder and bowel control, and even paralysis if left untreated. Diagnosis is primarily based on clinical evaluations, with imaging techniques like MRI aiding in identifying the site of compression. Treatment aims to relieve symptoms and restore function, often involving corticosteroids, radiation therapy, and possibly surgery. The prognosis varies, heavily influenced by the underlying cancer and the timing of intervention, with early detection being crucial for improving patient outcomes and quality of life.
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Spinal cord compression
DEFINITION: Spinal cord compression occurs as a result of tumor invasion of the spinal canal or vertebrae or from a primary tumor of the spinal cord pressing on the spinal cord and nerve roots. Occasionally, a malignant lymph node may grow to a size that can press on the cord. Metastasis, or the spread of cancer cells from the primary tumor site, accounts for 85 percent of the cases of spinal cord compression. The spinal cord controls motor, sensory, and other functions, including walking, breathing, and bowel and bladder control. Compression may occur anywhere along the spinal cord, from the neck to the lower back.
ALSO KNOWN AS: SCC, nerve root compression, spinal column compression, malignant spinal cord compression (MSCC)
RELATED CONDITIONS: Primary spinal cord tumors, metastatic tumors
Risk factors: The most significant risk factors are tumors in a higher stage, such as Stage III or Stage IV, because metastasis may already be present at diagnosis or cancers that do not respond well to treatment, leading to metastases. Breast, lung, prostate, bone, and renal cancers tend to have a greater risk of metastasis to the spinal cord. Gynecologic cancers tend to spread to the lower spine, and metastasizing breast and lung cancers affect higher areas in the spinal column. Primary tumors located in the spinal column, such as gliomas, pose a significant risk of cord compression.
Etiology and the disease process: The cause of spinal cord compression is generally mechanical, with a tumor pushing against the spinal cord’s thecal sac. The thecal sac surrounds the nerve roots and contains spinal fluid. When compression occurs, edema, inflammation, and nerve and circulation damage can result. Primary tumors of the spinal cord may originate inside the spinal column and cause pressure on the cord as the tumor expands. The vertebrae can be destroyed as the mass grows. Compression of the spinal cord begins with pain and weakness. If untreated, damage to the cord causes significant and permanent neurologic problems such as paralysis and an inability to control the bowel and bladder. If the compression is in the cervical area, where nerves control breathing, death can occur if a mechanical respirator is not employed until the compression is relieved.
Incidence: Malignant spinal cord compression occurs in 3 to 10 percent of cancer patients and 12 to 15 percent of patients with primary central nervous system tumors. Men have a slightly higher incidence of cord compression from primary tumors. Patients over fifty are more likely to experience cord compression from a metastatic tumor. Primary tumors affecting the spinal cord are seen more often in children and people between the ages of thirty and fifty.
Symptoms: In 90 percent of cases, pain is the first symptom. Symptoms often depend on the level of the spinal cord compression, but back pain is the main symptom regardless of site. The pain can be local or radiating. As the tumor grows, progressive symptoms occur, including tenderness to touch, muscle weakness, tingling or numbness, inability to feel hot and cold, loss of bladder and bowel control, difficulty breathing, and paralysis.
Screening and diagnosis: Patients at risk for spinal cord compression should be screened at each doctor’s visit for symptoms that indicate spinal cord compression. Educating the patient about which symptoms they should report to their doctor is critical to early intervention. Diagnosis is based on a careful history and physical examination to differentiate cord compression from other causes of symptoms. Back pain that does not get better with rest or lying down is diagnostic. Laboratory tests are not usually helpful. studies, such as X-rays to look for bone destruction and magnetic resonance imaging (MRI) to look at the entire spine, are more useful in identifying the site of damage. Staging is not used with spinal cord compression.
Treatment and therapy: The goals of treatment are to relieve pain, restore nerve function, support the spine, and control or reduce the tumor size. Treatment includes dexamethasone, a corticosteroid given intravenously over several days to reduce edema. Radiation therapy is the standard treatment when spinal cord compression is caused by tumor involvement. Treatments may range from five days to four weeks. Pain may be relieved in hours, but a spinal cord nerve function return may take several weeks to months. Surgery may stabilize the spine in some patients, but recovery and healing are difficult, especially after radiation. If the tumor is sensitive to chemotherapy, drugs may be used to support other treatments. If the patient fails to respond to therapy, palliative care or hospice referral to include pain management and supportive care may be the only option.
Prognosis, prevention, and outcomes: Because disease progression is the cause of spinal cord compression in 85 percent of cases, the prognosis for the patient is not good. Reversal of symptoms from spinal cord compression can occur with prompt intervention, leading to an improved quality of life. Prevention is based on disease control when metastatic disease is involved. There is no prevention of a primary tumor. Outcomes depend directly on controlling the underlying cancer and early intervention to relieve spinal cord compression and alleviate symptoms.
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