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Spinal Cord Neoplasms Follow-up

  • Author: J Stephen Huff, MD, FACEP; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
 
Updated: Feb 09, 2015
 

Further Outpatient Care

At the direction of the attending physicians, outpatient care may include ongoing chemotherapy, steroid administration, radiation therapy, or other treatments.

Physical therapy may be necessary.

Hospice referral may be indicated in some cases. A scoring system has been developed to identify patients with metastatic spinal cord compression who may be candidates for best supportive care.[8]

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Further Inpatient Care

Further inpatient care may include steroid administration, chemotherapy, or surgery ordered at the discretion of attending physicians.

Surgical decompression provides immediate relief of compression but may contribute to spinal mechanical instability. However, if instability is present from tumor destruction, surgery may be necessary for stabilization.

Recent research suggests that a combination of surgical decompression and radiation may be more effective than radiotherapy alone. This is an area of active investigation.[7]

Treatment is individualized and depends on tumor type, degree of neurologic function, and other factors.

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Transfer

Transfer may be necessary when specialized services are not accessible at the initial site of evaluation.

Consider administering steroids prior to transfer in cases of suspected spinal cord impairment caused by tumor.

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Complications

Potential complications of spinal cord neoplasms include the following:

  • Paraplegia
  • Quadriplegia
  • Urinary tract infections
  • Soft-tissue damage
  • Respiratory complications
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Prognosis

The prognosis for recovery of neurologic deficits secondary to spinal cord compression is related to the duration and severity of the impairment at the start of treatment.

Disturbances in sphincter function are associated with a poor prognosis for recovery.

Primary CNS spinal cord neoplasms are usually not metastatic and generally have a more favorable prognosis for long-term survival than do metastases.

Patients with leptomeningeal metastases have a poor prognosis.

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Contributor Information and Disclosures
Author

J Stephen Huff, MD, FACEP Professor of Emergency Medicine and Neurology, Department of Emergency Medicine, University of Virginia School of Medicine

J Stephen Huff, MD, FACEP is a member of the following medical societies: American Academy of Neurology, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Jeffrey L Arnold, MD, FACEP Chairman, Department of Emergency Medicine, Santa Clara Valley Medical Center

Jeffrey L Arnold, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Physicians

Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP Professor of Emergency Medicine, Professor of Internal Medicine, Program Director for Emergency Medicine, Case Medical Center, University Hospitals, Case Western Reserve University School of Medicine

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, Society for Academic Emergency Medicine, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians

Disclosure: Nothing to disclose.

Additional Contributors

Edmond A Hooker, II, MD, DrPH, FAAEM Associate Professor, Department of Health Services Administration, Xavier University, Cincinnati, Ohio; Assistant Professor, Department of Emergency Medicine, University of Cincinnati College of Medicine

Edmond A Hooker, II, MD, DrPH, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Public Health Association, Society for Academic Emergency Medicine, Southern Medical Association

Disclosure: Nothing to disclose.

References
  1. Spinazze S, Caraceni A, Schrijvers D. Epidural spinal cord compression. Crit Rev Oncol Hematol. 2005 Dec. 56(3):397-406. [Medline].

  2. Chamberlain MC, Tredway TL. Adult primary intradural spinal cord tumors: a review. Curr Neurol Neurosci Rep. 2011 Jun. 11(3):320-8. [Medline].

  3. Prasad D, Schiff D. Malignant spinal-cord compression. Lancet Oncol. 2005 Jan. 6(1):15-24. [Medline].

  4. Dugas AF, Lucas JM, Edlow JA. Diagnosis of spinal cord compression in nontrauma patients in the emergency department. Acad Emerg Med. 2011 Jul. 18(7):719-25. [Medline].

  5. Plank C, Koller A, Mueller-Mang C, Bammer R, Thurnher MM. Diffusion-weighted MR imaging (DWI) in the evaluation of epidural spinal lesions. Neuroradiology. 2007 Dec. 49(12):977-85. [Medline].

  6. Bilsky MH, Laufer I, Fourney DR, Groff M, Schmidt MH, Varga PP, et al. Reliability analysis of the epidural spinal cord compression scale. J Neurosurg Spine. 2010 Sep. 13(3):324-8. [Medline].

  7. Regine WF, Tibbs PA, Young A. Metastatic spinal cord compression: a randomized trial of direct decompressive surgical resection plus radiotherapy vs radiotherapy alone. Int J Radiat Oncol Biol Phys. 2003. 57 (suppl 2):5125.

  8. Piepenbrink JC, Cullen JI Jr, Stafford TJ. The use of video in anesthesia record keeping. Biomed Instrum Technol. 1990 Jan-Feb. 24(1):19-24. [Medline].

  9. Cole JS, Patchell RA. Metastatic epidural spinal cord compression. Lancet Neurol. 2008 May. 7(5):459-66. [Medline].

  10. Engelhard HH, Villano JL, Porter KR, et al. Clinical presentation, histology, and treatment in 430 patients with primary tumors of the spinal cord, spinal meninges, or cauda equina. J Neurosurg Spine. 2010 Jul. 13(1):67-77. [Medline].

  11. Sansur CA, Pouratian N, Dumont AS, Schiff D, Shaffrey CI, Shaffrey ME. Part II: spinal-cord neoplasms--primary tumours of the bony spine and adjacent soft tissues. Lancet Oncol. 2007 Feb. 8(2):137-47. [Medline].

  12. Schiff D. Spinal cord compression. Neurol Clin. 2003 Feb. 21(1):67-86, viii. [Medline].

  13. Schiff D, O'Neill BP. Intramedullary spinal cord metastases: clinical features and treatment outcome. Neurology. 1996 Oct. 47(4):906-12. [Medline].

  14. Schiff D, O'Neill BP, Suman VJ. Spinal epidural metastasis as the initial manifestation of malignancy: clinical features and diagnostic approach. Neurology. 1997 Aug. 49(2):452-6. [Medline].

  15. Traul DE, Shaffrey ME, Schiff D. Part I: spinal-cord neoplasms-intradural neoplasms. Lancet Oncol. 2007 Jan. 8(1):35-45. [Medline].

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Patient with metastatic breast cancer; plain radiograph shows L4 vertebral collapse.
MRI of plain film above showing intrusion of tumor and vertebral collapse into spinal canal.
Patient with renal cell carcinoma; MR shows collapse of a thoracic vertebra with spinal cord impingement.
Axial MR of patient in Media File 3 above with vertebral destruction and spinal cord impingement.
 
 
 
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