Spinal Cord Compression
Spinal cord compression is considered an oncologic emergency that requires prompt intervention. The spinal cord runs within the vertebral column (the bones of the back) and extends from the brainstem to the lumbar vertebral body level (lower back). Tumors that are growing within the spine can place pressure on the cord. Because the cord is circled by bone, a tumor growing within the spinal canal causes compression of the spinal cord against bone. The nerves can be irritated and permanently damaged if prompt treatment is not obtained.
A variety of tumors may cause spinal cord compression. Primary spinal tumors are relatively rare in the adult with an incidence of 1800-2000 per year in the United States. Metastatic tumors to the spine have an incidence of approximately 22,000 per year. The most common tumors to cause spinal cord compression are lung, breast, and prostate cancer; these are also the most common cancers overall.
New Back Pain Requires Evaluation
When a cancer patient develops new back pain, spinal cord compression is a concern. The symptoms of spinal cord compression correspond directly to the area of the spinal cord that is being compressed. Back pain is the most common presenting symptom. However, patients may also complain of weakness in the extremities and sensory changes. These symptoms can progress to loss of bowel and bladder control, loss of sensation below the level of the tumor, and paralysis. Progression of symptoms can be relatively rapid, thus prompt evaluation and treatment is critical. If you are a cancer patient with new or unusual back pain, inform your physician right away. Prompt treatment of the compression is important to prevent spinal cord damage from becoming permanent.
How is spinal cord compression diagnosed & treated?
A physician performs a complete history and physical exam, with special attention to a neurologic examination. If the physician is suspicious that a spinal cord compression may be present, an emergent MRI scan of the spine is performed. If the MRI confirms spinal cord compression, prompt treatment is initiated.
Treatment may include surgery, radiation therapy, and steroids. A neurosurgeon may recommend removal (decompression) of the mass pushing on the spinal cord. However, there are multiple factors that affect the decision to perform surgery, which are beyond the scope of this article. If surgery is an option, radiation therapy may be given 1-3 weeks after surgery to prevent the tumor from recurring in this area. If surgical decompression is not an option, external beam radiation therapy may be used to treat the tumor. Steroids (such as dexamethasone) may be used alone or in conjunction with radiation to decrease the swelling and pressure on the spinal cord.
Any cancer patient who develops new back pain and/or neurologic symptoms should notify their physician immediately. Prompt evaluation and treatment may prevent catastrophic results such as loss of bowel and bladder function and paralysis.