Summary
Definition
History and exam
Key diagnostic factors
- known cancer diagnosis
- ≥40 years of age
- back pain
- weakness or paralysis
- numbness or paresthesias
- sensory loss
- hyperreflexia and Babinski or associated reflexes
- bladder or bowel dysfunction
Other diagnostic factors
- cauda equina syndrome
- Brown-Sequard syndrome
Risk factors
- tumor type and metastases
- immune system disorders
- radiation exposure
- genotype features
Diagnostic tests
1st tests to order
- gadolinium-enhanced MRI spine
- MRI spine
- CT myelography
Tests to consider
- CT spine
- x-ray
- bone scintigraphy
- positron emission tomography (PET)
- tumor biopsy and histopathology
- serum calcium
- serum alkaline phosphatase
- cancer-specific laboratory testing
- cancer stem cell markers
Treatment algorithm
all patients
Contributors
Authors
Kenneth F. Casey, MD, FACS
Clinical Associate Professor Surgery (Neurosurgery)
Michigan State University
Clinical Associate Professor (Physical Medicine and Rehabilitation)
Wayne State University School of Medicine
Detroit
MI
Disclosures
KFC declares that he has no competing interests.
Lisa M. Ruppert, MD
Associate Attending Physiatrist
Department of Neurology-Rehabilitation Medicine Service
Memorial Sloan Kettering Cancer Center
Assistant Professor
Department of Rehabilitation Medicine
Weill Cornell Medical Center
New York
NY
Disclosures
LMR is an author of references cited in this topic.
Peer reviewers
Marcin Czyz, MD, PhD
Consultant Spine Neurosurgeon
Department of Neurosurgery
University Hospitals Birmingham NHS Trust
Birmingham
UK
Disclosures
MC declares that he has no competing interests.
Differentials
- Spinal epidural abscess
- Osteoporotic spinal compression fracture
- Intervertebral disk herniation/compression
More DifferentialsGuidelines
- ACR appropriateness criteria: thoracic back pain
- External beam radiation therapy for palliation of symptomatic bone metastases: an ASTRO clinical practice guideline
More GuidelinesPatient information
Spinal cord compression: what is it?
Spinal cord compression: what treatments work?
More Patient information- Log in or subscribe to access all of BMJ Best Practice
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