Spinal Cord Compression
Definition: Compression of the spinal cord somewhere along its length by a primary or secondary malignancy
• 5% of all cancer patients
• Average age: 58
• Vertebral column is the most common site of skeletal metastases
• 70% die within a year
• You are more at risk of developing SCC from the following:
• Your cancer has already spread to your bones or is at high risk of spreading to your bones, such as prostate, breast, lung or myeloma started in your spine.
How Does SCC present?
Often patients will complain about having a back pain. Usually a lower back pain and this pain radiates from their back and to the front of their abdomen and can feel like an elastic band around their waist. This is a common description of how SCC can feel when the patient is asked to describe their pain.
A sudden change in continence, Patients that are suddenly become incontinent or become symptomatic of peri-anal numbness, this can be a common sign that someone is experiencing SCC.
On the flip side to that, another symptom can be retention or urinary hesitation, has there been a marked changed in how the patient passes urine, are they not able to pass any at all? Sometimes, in patients that isunable to answer questions like these, such as patients with dementia or other cognitive condition that may affect a patient communicating with you, you can see if their bladder is palpable or distended and this can signify urinary retention.
Other common side affects with SCC:
Constipation.
Sudden lack of mobility or sensory level from the waist down. It is important to recognize if your patientssudden decline in mobility is from disease deterioration or from SCC. Sudden change in mobility is rare as deterioration can happen over weeks/months and if your patient was walking independently 1 day ago and is now bed bound, this could be more than just disease deterioration.
Sites of Compression:
The most common site of compression is in the Thoracic, this can appear in 70% of cases of SCC, Followed by the Lumbosacral found in 20% and then least common is the Cervicalregion found in 10% of SCC.
Management of SCC
• Rapid diagnosis & management is essential in SCC.
– For pain, limb function, sphincter control.
– Paraplegia irreversible. If SCC is not treated within 24 hours there is a very high chance that the patient can become paraplegic.
• Immediate high dose steroids
– Dexamethasone 8mg bd iv/sc/po (+ PPI)
– Definitive treatment within 24hrs;
– Radiotherapy
– Surgery
– Chemotherapy
Clare Troy
Ref:
cancerresearch.co.uk