Spinal Cord Neoplasms Treatment & Management

  • Author: J Stephen Huff, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP   more...
 
Updated: Dec 7, 2010
 

Prehospital Care

Use of spinal immobilization precautions may be prudent when neurologic impairment is suggested.

Support airway, breathing, and circulation during transport.

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Emergency Department Care

Spinal cord compression secondary to cancer is an emergency that requires rapid diagnosis and treatment to prevent permanent complications.

Even when a cure is not possible, timely diagnosis and treatment may improve the patient's quality of life.

Consider administering steroids to patients who are thought to have cord compression secondary to a neoplasm.

Chemotherapy has a limited role in treating spinal cord dysfunction and should be administered at the discretion of the consultant.

Radiation therapy

Radiation treatment to areas of tumor compression should be pursued after appropriate imaging and consultation.

Cord compression from an epidural tumor is considered one of the few emergencies in radiation oncology.

Spinal cord tolerance to radiation depends on the fraction size and cumulative dose.

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Consultations

Neurosurgeons traditionally manage spinal cord compression and dysfunction; however, local practices may vary.

Oncology, neurology, and radiation oncology staff may be involved in some circumstances.

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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

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, 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

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  3. 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].

  4. 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.

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  7. Newton HB, Shah SML. Neurological syndromes and symptoms in the cancer patient: differential diagnosis, assessment protocols, and targeted clinical interventions. Emerg Med Rep. 1997;18:149-58.

  8. Patten J. The spinal cord in relation to the vertebral column. In: Neurologic Differential Diagnosis. 1996:247-81.

  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. Schmidt RD, Markovchick V. Nontraumatic spinal cord compression. J Emerg Med. Mar-Apr 1992;10(2):189-99. [Medline].

  14. 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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