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
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  • 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)
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  • 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
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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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