Spinal Cord Neoplasms Workup

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

Laboratory Studies

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 insults. 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.

Next

Imaging Studies

MRI

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.

MRI of plain film above showing intrusion of tumorMRI of plain film above showing intrusion of tumor and vertebral collapse into spinal canal.

The intervertebral space is usually not involved in tumors of the spine. When the disk space is obliterated, infection is more likely.

Diffusion-weighted MR imaging may be useful in evaluation of epidural neoplastic lesions.[5]

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 radiography

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.

Patient with metastatic breast cancer; plain radioPatient with metastatic breast cancer; plain radiograph shows L4 vertebral collapse.

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.

Nuclear medicine

Most tumors (excluding myeloma) exhibit increased activity on nuclear medicine scans.

Previous
Next

Procedures

  • Lumbar puncture
    • 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.
Previous
Proceed to Treatment & Management
 
 
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].

 
Previous
Next
 
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.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.