Summary
Definition
History and exam
Key diagnostic factors
- 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
Other diagnostic factors
- síndrome da cauda equina
- Síndrome de Brown-Sequard
Risk factors
- tipo de tumor e metástases
- distúrbios do sistema imunológico
- exposição à radiação
- características genotípicas
Diagnostic investigations
1st investigations to order
- RNM da coluna com realce de gadolínio
- RNM da coluna vertebral
- mielotomografia
Investigations to consider
- 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
Treatment algorithm
todos os pacientes
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.
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 tratamentos funcionam?
Compressão da medula espinhal: o que é?
More Patient information
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer