eMedicine Specialties > Emergency Medicine > Hematology & Oncology

Neoplasms, Spinal Cord: Treatment & Medication

Author: J Stephen Huff, MD, Associate Professor, Emergency Medicine and Neurology, Department of Emergency Medicine, University of Virginia Health Sciences Center
Contributor Information and Disclosures

Updated: Jul 1, 2009

Treatment

Prehospital Care

  • Use of spinal immobilization precautions may be prudent when neurologic impairment is suggested.
  • Support airway, breathing, and circulation during transport.

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.

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.

Medication

Dexamethasone administration may acutely preserve neurologic function in patients with epidural spinal cord compression. Opinions regarding dosages vary (eg, 4-100 mg q6h).

Corticosteroids

These agents have anti-inflammatory properties and cause profound and varied metabolic effects. In addition, they modify the body's immune response to diverse stimuli. With therapy, tumor-associated edema and cord compression, particularly those caused by metastatic tumors, may diminish.


Dexamethasone (Decadron, Hexadrol)

Used in the treatment of various inflammatory diseases. Mechanism of action in neurologic function not completely understood. Many physicians prefer higher-dose regimens (100 mg initial bolus).

Adult

4-100 mg IV bolus followed by 16-96 mg/d in divided doses; taper over several days

Pediatric

Not established
Suggested dose: 0.08-0.3 mg/kg/d IV or 2.5-10 mg/m2/d IV divided q6-12h

Effects decrease with coadministration of barbiturates, phenytoin, and rifampin; dexamethasone decreases effect of salicylates and vaccines used for immunization

Documented hypersensitivity; active bacterial or fungal infection

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Increases risk of multiple complications, including severe infections; monitor adrenal insufficiency when tapering drug; abrupt discontinuation of glucocorticoids may cause adrenal crisis; hyperglycemia, edema, osteonecrosis, myopathy, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, myasthenia gravis, growth suppression, and infections are possible complications

More on Neoplasms, Spinal Cord

Overview: Neoplasms, Spinal Cord
Differential Diagnoses & Workup: Neoplasms, Spinal Cord
Treatment & Medication: Neoplasms, Spinal Cord
Follow-up: Neoplasms, Spinal Cord
Multimedia: Neoplasms, Spinal Cord
References
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References

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

  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.

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

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Further Reading

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Keywords

spinal cord neoplasm, spinal cord tumor, neoplastic disease, spinal cord compression, primary spinal cord tumors, metastatic lesions, spinal cord dysfunction, spinal cord metastasis, epidural spinal cord compression, partial cord compression, Brown-Sequard syndrome, hemangiomas, scoliosis, torticollis, vertebral metastasis, leptomeningeal metastasis

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Contributor Information and Disclosures

Author

J Stephen Huff, MD, Associate Professor, Emergency Medicine and Neurology, Department of Emergency Medicine, University of Virginia Health Sciences Center
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.

Medical Editor

Edmond A Hooker II, MD, DrPH, FAAEM, Assistant Professor, Department of Health Services Administration, Xavier University; Associate Clinical Professor, Department of Emergency Medicine, University of Louisville; Assistant Clinical Professor, Department of Emergency Medicine, Wright State 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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

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.

CME Editor

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, University Hospitals, Case Medical Center
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.

 
 
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