Spinal Cord Neoplasms Workup
- Author: J Stephen Huff, MD, FACEP; Chief Editor: Barry E Brenner, MD, PhD, FACEP more...
Laboratory studies are not generally helpful in establishing the diagnosis of spinal cord neoplasm.
Marked elevation of the erythrocyte sedimentation rate suggests infection or inflammation.
Patients with a suspected spinal cord neoplasm are at risk for additional oncologic issues. Routine blood workup typically includes analysis of the following: CBC; prothrombin time; activated partial thromboplastin time; and metabolic profile, including calcium level and liver function.
MRI of the affected area provides the best definition of spinal lesions and is the procedure of choice.
With MRI, the entire spine may be visualized rapidly (sagittal images), and images may be obtained in multiple planes for best definition of the lesion, vertebrae, epidural space, and spinal cord. Roughly one third of people with spinal epidural metastases have multiple spinal metastases.
MRI can usually be used to differentiate a collapsed vertebra secondary to osteoporosis or trauma from malignant disease.
The intervertebral space is usually not involved in tumors of the spine. When the disk space is obliterated, infection is more likely.
If MRI cannot be performed, consult a qualified radiologist or oncologist about other imaging options (eg, intrathecal contrast-enhanced myelography, CT scan, nuclear medicine bone scanning).
Plain radiographs may reveal bony destruction (osteolytic or osteoblastic lesions), vertebral collapse or subluxation, or calcification (associated with a meningioma). Roughly 50% of the bone must be destroyed to be visible on plain films.
Conventional radiographs do not provide information about spinal cord structure or compression.
Changes are demonstrated on plain films in about 80% of patients with spinal cord tumors. Conversely, findings on plain films are falsely negative in about 20% of cases.
Most tumors (excluding myeloma) exhibit increased activity on nuclear medicine scans.
See the list below:
- Be cautious when considering a lumbar puncture; the presence of a spinal cord tumor is a relative contraindication to the performance of a lumbar puncture.
- Removal of cerebrospinal fluid in the presence of a tumor may worsen cord compression.
- In leptomeningeal metastasis, examination findings of the spinal fluid are almost always abnormal and reveal elevated protein levels and positive cytologic results.
Post-void residual urine volume: Have the patient urinate and check the urinary residual volume by catheterization when bladder impairment is a concern. Volumes greater than 200 mL may suggest a neurogenic bladder.
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