Back pain in malignant disease metastatic spinal cord. Spinal cord compression management in cancer patients page 1 of 6 department of clinical effectiveness v4 approved by the executive committee of the medical staff on 01292019 suspected spinal cord compression. Spinal cord compression scc is a lifethreatening complication of pri mary and metastatic cancer that can significantly impact a patients quality of life. Metastatic spinal cord compression diagnosis and management. Spinal cord compression management in cancer patients page 2 of 6 disclaimer. Neurological function and quality of life can be preserved if patients receive an early diagnosis and.
The spine is involved in up to 40% of those patients. Thoracic ependymoma with severe spinal cord compression. Controversy surrounds the care for patients with metastatic spinal cord compression. Myelography should only be undertaken at a neuroscience or spinal surgical centre because of the technical expertise required and because patients with metastatic spinal cord compression mscc may deteriorate following myelography and require urgent decompression. Spinal cord compression may develop in 5% to 10% of cancer.
We explain what metastatic spinal cord compression mscc is, what symptoms to look out for, and how mscc is treated. Spinal cord compression management in cancer patients page 1 of 6 department of clinical effectiveness v4 approved by the executive committee of the medical staff on 01292019 suspected spinal cord compression 16 severe pain or abnormal neurology, or incidental finding on mri not intended for traumatic injuries. This retrospective study was performed to identify prognostic factors for functional outcome, local control of mscc, and survival in 175 of such patients treated with radiotherapy alone. Spinal cord compression management in cancer patients page. Thoracic exophytic ependymoma with severe spinal cord compression. Everything nice has said on detecting and managing metastatic spinal cord compression in adults with cancer in an interactive flowchart metastatic spinal cord compression nice pathways az. Do they have symptoms of metastatic spinal cord compression mscc.
Prompt diagnosis and treatment are critically important. Management of pain and spinal cord compression in patients with advanced cancer janet l. Spinal cord compression can be caused by any condition that puts pressure on the spinal cord. Spinal cord compression is suggested by spinal or radicular pain with reflex, motor, or sensory deficits, particularly at a segmental level. Malignant spinal cord compression mscc is one of the most devastating complications of cancer.
Mri evidence of spinal metastases with stenosis of the spinal canal due to tumour or vertebral angulation without compression of the cord or cauda equina epidural spinal cord compression scale. Metastatic spinal cord compression mscc is defined as spinal cord or cauda equina compression by direct pressure andor induction of vertebral collapse or instability by metastatic spread or direct extension of malignancy that threatens or causes neurological disability 80. The minimum radiological evidence for a diagnosis of spinal cord. This algorithm has been developed for md anderson using a multidisciplinary approach considering circumstances particular to md andersons specific patient population, services and structure, and clinical information. Epidural spinal cord compression from metastatic tumor. Understanding spinal cord compression spinal cord compression scc is a lifethreatening complication of primary and metastatic cancer that can significantly impact a patients quality of life. Pain suggestive of spinal mets pain in the thoracic or cervical spine progressive lumbar spinal pain severe unremitting lumbar spinal pain spinal pain aggravated by straining localised spinal tenderness nocturnal spinal pain preventing sleep question 2. Maliganant spinal cord compression main slideshare.
Prognostic factors for different outcomes in patients with. Spinal cord compression guidelines page 4 of 28 guidelines for the dagnosis and management of adults at risk of and with metastatic spinal cord compression key points 1. Metastatic spinal cord compression and steroid treatment. Sometimes a cancer grows in the bones of the spine or in the tissues around the spinal cord. Guidelines for suspected spinal cord compression in children. Metastatic spinal cord compression overview nice pathways bring together everything nice says on a topic in an interactive flowchart. Spinal cord compression scc occurs in 5% to 30% of the oncology population and affects patient function, comfort, and general quality of life. Patients with symptoms suggestive of spinal cord compression, particularly severe back or root pain 1 should be investigated urgently with whole spine. Metastatic spinal cord compression mscc is defined in this guideline as spinal cord or cauda equina compression by direct pressure andor induction of vertebral collapse or instability by metastatic spread or direct extension of malignancy that threatens or causes neurological disability. Patients with cancer of unknown primary account for 10% of patients with metastatic spinal cord compression mscc. The resulting spinal cord injury may be acute, subacute, or chronic and occurs due to direct cord damage, by compression andor infiltration, or by compromise of the vascular supply to the cord. Information about recognising the symptoms of metastatic spinal cord compression quality statement adults at high risk of developing metastatic spinal cord compression mscc, and their families or carers as appropriate, are given information that describes the symptoms of mscc and what to do if they develop symptoms. Definition of metastatic spinal cord compression mscc mscc metastatic or malignant spinal cord compression is where a cancer or metastasis presses on and subsequently compresses the spinal cord.
Malignant spinal cord compression you have been given this leaflet because you have cancer and are at risk of developing malignant spinal cord compression mscc. Clinical pathways of metastatic spinal cord compression. Metastatic spinal cord compression pathway guidelines for. Spinal cord compression management in cancer patients page 1 of 6. Early detection metastatic spinal cord compression. The tumors that most often cause spinal cord compression from epidural metastases or bone destruction are carcinomas of the lung, breast, and prostate and multiple myeloma. Metastatic spinal cord compression mscc is defined in the national institute of health and clinical excellence nice guidelines as spinal cord or caudaequina compression by direct pressure andor induction of vertebral collapse by metastatic spread or direct extension of malignancy that threatens neurological disability. Because of the rapid progression of the neurological dysfunction, it is. They are considered to be intraaxial in location and can be either primary or metastatic. Spinal metastases are becoming increasingly common because patients with metastatic disease are living longer. The leaflet explains what mscc is and what symptoms to look out for. Malignant spinal cord compression royal college of physicians. Spinal cord tumors can occur within or adjacent to the spinal cord.
Spinal cord compression management in cancer patients. Metastatic spinal cord compression guidelines november 2018 objectives 1. All generic steroid formulations were included along with spinal cord compression or myelopathy combined with metastatic or malignant tumors. Patients with spinal cord compression have complex. Purpose metastatic spinal cord compression mscc can be a catastrophic manifestation of advanced cancer that causes immobilizing pain and significant neurologic impairment.
Approximately 70% of cancer patients have metastatic disease at death. Mscc is a rare condition but it is potentially serious. It also tells you what to do if you develop symptoms. Spinal cord compression mri spine confirms spinal cord compression keep patient on bedrest with flowtrons and heparin start dexamethasone 8 mg po bd and a ppi speak to neuro surgery, if there is. Management pathway for metstatic spinal cord compression. Patients often present with a history of progressive pain.
Identified by the oncology nursing society as a structural oncologic emergency, scc occurs. Symptoms and signs in metastatic spinal cord compression. Acr appropriateness criteria acr appropriateness criteria metastatic epidural spinal cord compression and recurrent spinal metastasis metastatic epidural spinal cord compression and epidural spinal cord compression. Cauda equina syndrome is caused by compression of these nerves compression can occur by trauma, vertebral fracture or displacement, disc herniation, a tumour or metastatic. This fact sheet is for men with advanced metastatic prostate cancer that has spread to the bones. Although spinal cord compression occurs in a variety of malignancies, the most common are lung, breast, unknown primary, prostate, and renal cancers, as well as lymphoma and myeloma.
Pdf management of metastatic spinal cord compression. Pretreatment performance is the main determinant of posttreatment outcome and patients able to walk at the time. Presentation of metastatic spinal cord compression mscc. The clinical findings in consecutive cases of spinal cord compression by metastatic extradural tumors were analyzed. Abrahm, md, for the acpasim endoflife care consensus panel general internists often care for patients with advanced cancer. Metastatic epidural spinal cord compression and recurrent. Assessment and management of patients with metastatic. The symptoms of spinal cord compression are caused by the increasing pressure compression on the spinal cord and nerves. Posterior decompression and spine stabilization for metastatic spinal cord compression in the cervical spine. Guidelines for the rehabilitation of patients with.
Inform the patient urgent discussion with oncologist directly or via local acute oncology service if available. Management of pain and spinal cord compression in patients. Prompt treatment while the patient is still ambulant or even within 24 hours of the onset of neurological deficit is. In response to this problem, an innovative multidisciplinary approach has been developed for the management of spinal metastases. Clinical interest in spinal compression and resultant paraplegia due to metastases has mounted in recent years. Malignant spinal cord compression mscc is believed to occur in approximately 5% of all patients with cancer and is a major cause of morbidity. We are committed to promoting best practice by reducing delays and avoidable disability, including preventing paralysis, from adversely affecting the quality of life for people with metastatic spinal cord compression. This results in swelling and a reduction in the blood supply to the spinal cord and nerve roots. Symptoms of spinal cord syndrome pain motor sensory autonomic 12.
Metastatic spinal cord compression mscc key red flags past medical history of cancer but note 25% patients do not have diagnosed primary early diagnosis is essential as the prognosis is. Metastatic spinal cord compression mscc compression of the dural sac and its contents spinal cord and or cauda equina by an extradural tumour mass. Malignant spinal cord compression mscc is a common and debilitating neurological. Apr 27, 2011 metastatic spinal cord compression is defined radiographically as an epidural metastatic lesion causing true displacement of the spinal cord from its normal position in the spinal canal. Pdf metastatic spinal cord compression mscc is a potentially life changing oncological emergency.
Management of metastatic spinal cord compression article pdf available in southern medical journal 1109. Introduction metastatic spinal cord compression in. Spinal cord compression can occur acutely in children with cancer. Metastatic spinal cord compression mscc is defined in this guideline as spinal cord or cauda equina compression by direct pressure andor induction of vertebral collapse or instability by metastatic spread or direct extension of malignancy that threatens or causes neurological. Metastatic spinal cord compression mscc prostate cancer uk. Patients with lung cancer, breast cancer, prostate. It can happen if the vertebrae are damaged or collapse. It can also develop if a tumour puts pressure on the spinal cord. Patients with metastatic spinal cord compression mscc can often first present to healthcare professionals with pain and is an oncological emergency. Oncology emergency series understanding spinal cord compression. The resulting spinal cord injury may be acute, subacute, or chronic and occurs due to direct cord damage, by compression. The thoracic 70% and lumbar spine 20% are the most common site involved.
Compression of the spinal cord can result from trauma, cancer, epidural abscess, or epidural hematoma and can have a variety of clinical manifestations based on the anatomical level and completenes. Pdf radiotherapy of metastatic spinal cord compression. Ovarian cancer patients developing metastatic spinal cord compression mscc are extremely rare and account for only 0. Spinal cord compression neurologic disorders msd manual. Metastatic spinal cord compression is defined radiographically as an epidural metastatic lesion causing true displacement of the spinal cord from its normal position in the spinal canal. Metastatic spinal cord compression mscc this fact sheet is for men with advanced metastatic prostate cancer that has spread to the bones. Treating metastatic spinal cord compression nice pathways bring together everything nice says on a topic in an interactive flowchart. We talk about a condition called metastatic spinal cord compression. Radiotherapy of metastatic spinal cord compression.
Radiotherapy of metastatic spinal cord compression in very. West of scotland guidelines for malignant spinal cord. The management and treatment of metastatic spinal cord. This has stimulated attention to the neuropathology of the condition. Spinal cord compression occurs when something presses down with sufficient force on the nerves within the spinal cord so that they lose their ability to function properly. Primary spinal cord tumors account for 2 to 4 percent of all primary central nervous system cns tumors, onethird of which are located in the intramedullary compartment. Malignant spinal cord compression mirjana rajer and vilijem kovac department of radiotherapy, institute of oncology ljubljana, ljubljana, slovenia background.
Any type of cancer can spread to the bones of the spine, which may lead to spinal cord compression. Spinal cord compression occurs mainly secondary to degenerative disease, or spinal metastases. Recognising metastatic spinal cord compression british. Management pathway for metstatic spinal cord compression 25. Suspected spinal cord compression in children and young people compression of the spinal cord andor cauda equina is an oncological emergency that may lead to permanent, avoidable paralysis if not treated effectively. Metastatic spinal cord compression mscc is defined in the national institute of health and clinical excellence nice guidelines as spinal cord or caudaequina compression by direct pressure andor induction of vertebral collapse by metastatic.
The close proximity of the spinal cord to the vertebral column limits many conventional therapeutic options that can otherwise be used to treat cancer. Pain usually first symptom 8090% of the time usually precedes other neurologic symptoms by 7 weeks increases in intensity severe local back pain aggravated by lying down distension of venous plexus bach, f, larsen, bh, rohde, k, et al. Spinal cord metastasis an overview sciencedirect topics. Metastatic spinal cord compression is a feature of advanced cancer and the incidence is likely to increase alongside improved survival rates. These patients have substantial morbidity caused by moderate to severe pain and by spinal cord compression. Can occur as a result of spine trauma, vertebral compression fracture, intervertebral disk herniation, primary or metastatic spinal tumor, or infection. Jan 24, 2018 metastatic spinal cord compression mscc is an oncological emergency that describes when tumours usually having spread from another part of the body grow in the spinal column and compress the. Guidelines for the rehabilitation of patients with metastatic. Metastatic spinal cord compression mscc is defined in this guideline as spinal cord or cauda equina compression by direct pressure andor induction of vertebral collapse or instability by metastatic.
Early detection metastatic spinal cord compression ncbi. Papers discussing acute traumatic causes of spinal cord compression were excluded, as were papers discussing cord compression from nonmetastatic tumors or epidural lipomatosis. Metastatic spinal cord compression mscc is defined in this guideline as spinal cord or cauda equina compression by direct pressure andor induction of vertebral collapse or instability by metastatic spread or direct extension of malignancy that threatens or causes neurological disability doh, 2008 1. Oct 26, 20 metastatic spinal cord compression affects 5 to 14% of all cancer patients. Malignant spinal cord compression mscc is a common and debilitating neurological complication of cancer.
If mri whole spine confirms impending spinal cord compression, thecal indentation or overt mscc then manage as mscc. Patients with symptoms suggestive of spinal cord compression, particularly severe back or root pain 1 should be investigated urgently with whole spine mri to define. To ensure that all patients at risk of mscc receive patient information leaflet spinal cord compression what you need to. Radiotherapy is effective for metastatic spinal cord. Pretreatment performance is the main determinant of posttreatment outcome and patients able to walk at the time of treatment maintain functional independence better and survive longer.
The most common cause of spinal cord compression in people with cancer is metastasis to the spine. Radiotherapy of metastatic spinal cord compression in very elderly patients article in international journal of radiation oncologybiologyphysics 671. Posterior decompression and spine stabilization for. The south west london metastatic spinal cord compression. These patients were combined with a previous survey of 105 patients to. Your partner, family or friends might also find it helpful. Eligible pts had spinal cord or cauda equina c1s2 compression. Can occur as a result of spine trauma, vertebral compression fracture, intervertebral disc herniation, primary or metastatic spinal tumour, or infection. Metastatic spinal cord compression mscc is defined as spinal cord or cauda equina compression by direct pressure andor induction of vertebral collapse or instability by metastatic spread, collapse or.
The term spinal cord compression is usually reserved for cases in which the presence of atumorresults in pressure on the spinal cord. Metastatic spinal cord compression mscc is a potentially life changing oncological emergency. Pdf cancer metastasis is a key event in tumor progression associated not only with mortality but also significant morbidity. Pts from 43 uk and 4 australian sites were randomized 1. Patients who develop spinal metastases are at risk of irreversible spinal cord damage.
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