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Spinal Cord Neoplasms Treatment & Management

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

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 compression 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.



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.

Contributor Information and Disclosures

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.

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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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