Malignant Spinal Cord Compression

KEYPOINTS

• A palliative care emergency
• Common in multiple myeloma, prostatic, renal and breast cancer
• Many patients can live a relatively long time with added burden of paralysis

• Can occur with sarcoma (Ewing's especially), but also neuroblastomas, germ cell tumours, lymphomas and primary CNS tumours

ASSESSMENT

(see Foreword)

• A high level of suspicion is required. Increasing back pain is often the earliest sign, with sensory, motor and neurological symptoms occurring later on

MANAGEMENT

• While awaiting confirmation by imaging, initiation of high doses of steroids (dexamethasone 20 mg once daily or more in adults)

• Dexamethasone
  • 2-5 years: 0.5-1 mg bid PO/SC/IV
  • 6-12 years: 1-2 mg bid PO/SC/IV
  • 12 (plus): 2-4 mg bid PO/SC/IV

• Once confirmed, emergency referral for radiation therapy or sometimes for surgical decompression

Consider if patient is well enough to benefit from investigation or treatment

PITFALLS/CONCERNS

• Delay in diagnosis or treatment may result in preventable paralysis

PALLIATIVE TIPS

• Back pain exacerbated by the Valsalva manoeuvre should increase suspicion for developing cord compression

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