Spinal Cord Compression

• Symptoms: pain (worse supine), weakness, numbness/parasthesias, urinary retention, ataxia

• Causes: breast, prostate, lung cancer account for 60% of cases
  • 20% of cases are initial presentation of malignancy
  • 90% from hematogenous seeding, 10% from direct invasion
  • Most common location is thoracic spine, which has implications for imaging protocol
  • In multiple myeloma, compression can occur from plasmacytoma, or pathologic fracture from osteolysis

  • Pathophysiology:

          - 85-90% from hematogenous seeding, 10% from direct invasion

          - Obstruction of epidural venous plexus --> vasogenic edema --> venous infarction

• Diagnosis:
  • MR gold standard, as it images cord, soft tissue, bone
    • Should image entire spine, as 60% lesions occur in thoracic spine (should always consider imaging thoracic and lumbar spine, as long as cervical pathology is ruled out by exam)
  • CT myelogram: invasive
  • CT: does not image cord clearly, but can demonstrate mets to bone

• Treatment:
  • Glucocorticoids: evidence is not great (3 small studies), but given potential benefit (and risk
    • The role of high dose (100mg) pulse dexamethasone vs low dose (10mg) is unclear
  • Surgery + XRT superior to XRT alone

(Christopher Woo MD, 7/13/10, 1/6/11)