Spinal Cord Neoplasms Follow-up

  • Author: J Stephen Huff, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP   more...
 
Updated: May 7, 2012
 

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.[6]

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

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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.

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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  Associate Professor of Emergency Medicine and Neurology, Department of Emergency Medicine, University of Virginia School of Medicine

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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

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, and Southern Medical Association

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

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 and American College of Physicians

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

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 Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References

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

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

  3. Prasad D, Schiff D. Malignant spinal-cord compression. Lancet Oncol. Jan 2005;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. Jul 2011;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. Dec 2007;49(12):977-85. [Medline].

  6. 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.

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

  8. 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. Jul 2010;13(1):67-77. [Medline].

  9. 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. Feb 2007;8(2):137-47. [Medline].

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

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

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

  13. Traul DE, Shaffrey ME, Schiff D. Part I: spinal-cord neoplasms-intradural neoplasms. Lancet Oncol. Jan 2007;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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