Compressão maligna da medula espinhal
Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- diagnóstico de câncer conhecido
- ≥40 anos de idade
- dorsalgia
- fraqueza ou paralisia
- dormência ou parestesias
- perda sensitiva
- hiper-reflexia e Babinski ou reflexos associados
- disfunção da bexiga ou do intestino
Outros fatores diagnósticos
- síndrome da cauda equina
- Síndrome de Brown-Sequard
Fatores de risco
- tipo de tumor e metástases
- distúrbios do sistema imunológico
- exposição à radiação
- características genotípicas
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- RNM da coluna com realce de gadolínio
- RNM da coluna vertebral
- mielotomografia
Investigações a serem consideradas
- tomografia computadorizada (TC) da coluna vertebral
- radiografia
- cintilografia óssea
- tomografia por emissão de pósitrons (PET)
- biópsia do tumor e histopatologia
- cálcio sérico
- fosfatase alcalina sérica
- exames laboratoriais específicos para câncer
- marcadores de células-tronco cancerígenas
Algoritmo de tratamento
todos os pacientes
Colaboradores
Autores
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
Declarações
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
Declarações
LMR is an author of references cited in this topic.
Revisores
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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
American College of Radiology. ACR appropriateness criteria®: management of vertebral compression fractures. 2022 [internet publication].Full text
National Institute for Health and Care Excellence. Spinal metastases and metastatic spinal cord compression. Sep 2023 [internet publication].Full text
American College of Radiology. ACR appropriateness criteria®: low back pain. 2021 [internet publication].Full text Abstract
American College of Radiology. ACR appropriateness criteria®: thoracic back pain. 2024 [internet publication].Full text
Alcorn S, Cortés ÁA, Bradfield L, et al. External beam radiation therapy for palliation of symptomatic bone metastases: an ASTRO clinical practice guideline. Pract Radiat Oncol. 2024 May 22:S1879-8500(24)00099-7.Full text Abstract
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: central nervous system cancers [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Abscesso epidural espinhal
- Fratura osteoporótica por compressão vertebral
- Hérnia/compressão de disco intervertebral
More DifferentialsGuidelines
- NCCN clinical practice guidelines in oncology: central nervous system cancers
- External beam radiation therapy for palliation of symptomatic bone metastases: an ASTRO clinical practice guideline
More GuidelinesPatient information
Compressão da medula espinhal: quais são as opções de tratamento?
Compressão da medula espinhal: o que é?
More Patient information
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