Malignant spinal cord compression

Malignant spinal cord compression (MSCC) is caused by metastatic or direct tumour spread into the epidural space.

Tumours affecting the spinal column are often classified by their location as extradural, intradural extramedullary, or intradural intramedullary. Metastatic extradural (epidural) tumours are the most common type of spine tumour.

Acute spinal cord compression is a medical emergency. Urgent diagnosis and treatment is essential to prevent irreversible spinal cord injury and disability.

Diagnosis of MSCC is by magnetic resonance imaging (MRI) of the whole spine, preferably with gadolinium enhancement. Computed tomography myelography can be used if MRI is contraindicated or unavailable.

Treatment usually involves corticosteroids initially, followed by radiotherapy with or without surgery as appropriate to the patient's circumstances.

Prognosis is more favourable for previously ambulatory patients and for patients who have been immobile for less than 24 hours.

Malignant spinal cord compression (MSCC) is caused by a tumour pressing on the spinal cord or cauda equina. Spinal tumours can be primary, or secondary to metastatic disease (e.g., of breast, prostate, or lung cancer). Presenting symptoms of MSCC include back and/or neck pain (which is usually the first symptom), limb weakness, sensory symptoms such as loss of sensation, and bladder and/or bowel dysfunction. Tumours affecting the spinal column can be classified by their location as extradural, intradural extramedullary, or intradural intramedullary.[1]Mechtler LL, Nandigam K. Spinal cord tumors: new views and future directions. Neurol Clin. 2013 Feb;31(1):241-68. http://www.ncbi.nlm.nih.gov/pubmed/23186903?tool=bestpractice.com All tumour types will be mentioned but the focus of this topic is on metastatic epidural disease causing cord compression.