Prehospital Care
Use of spinal immobilization precautions is 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.
In cancer patients with clinical suspicion of spinal cord compression, dexamethasone should be initiated. This should be followed promptly by surgical decompression, when possible, and radiation therapy. [7] See Follow-up: Further Inpatient Care.
A Cochrane review found a lack of evidence-based guidance around how to correctly position and when to mobilize patients with metastatic spinal cord compression, and whether spinal bracing is effective for reducing pain or improving quality of life. Caution should be used, as mobilization may be hazardous in the presence of spinal instability; further vertebral collapse can occur. [8]
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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Patient with metastatic breast cancer; plain radiograph shows L4 vertebral collapse.
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MRI of plain film above showing intrusion of tumor and vertebral collapse into spinal canal.
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Patient with renal cell carcinoma; MR shows collapse of a thoracic vertebra with spinal cord impingement.
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Axial MR of patient in Media File 3 above with vertebral destruction and spinal cord impingement.
