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Malignant Spinal Cord Compression

Time-critical recognition and treatment of metastatic epidural disease threatening neurologic function

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Onkoloji department. Book Appointment →

What is Malignant Spinal Cord Compression?

Malignant spinal cord compression occurs in five to fourteen percent of patients with cancer and is most often caused by metastatic breast, prostate, lung, or renal carcinoma and multiple myeloma. The mechanism involves vertebral body collapse with retropulsion of bone fragments and direct epidural tumor extension that compress the cord at the thoracic level in two-thirds of cases.

Back pain that is worse at night or with recumbency is the earliest and most common symptom and may precede neurologic deficit by weeks. Progressive bilateral leg weakness, sensory level, sphincter dysfunction, and lower motor neuron findings at the cauda equina level signal advanced compression that threatens permanent paraplegia.

Management requires same-day high-dose dexamethasone, urgent magnetic resonance imaging of the entire spine, and immediate consultation for surgical decompression with stabilization in eligible patients followed by radiotherapy. Conventional fractionated external beam radiotherapy or stereotactic body radiotherapy is used for radiosensitive tumors or non-surgical candidates. Multidisciplinary review with rehabilitation is essential.

Symptoms

Severe back pain worse at night
Progressive bilateral leg weakness
Sensory level on examination
Urinary retention or incontinence
Saddle anesthesia in cauda equina compression

Risk Factors

Metastatic breast or prostate cancer
Lung cancer or renal cell carcinoma
Multiple myeloma or lymphoma
Known vertebral metastasis
Recent rapid increase in back pain

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • When new severe back pain appears in cancer
  • When pain is worse at night or lying flat
  • When leg weakness develops
  • When urinary retention or numbness occurs
  • When sensory level is identified

Treatment Methods

01
Immediate high-dose dexamethasone
02
Urgent magnetic resonance imaging of entire spine
03
Surgical decompression with stabilization in eligible cases
04
Postoperative radiotherapy
05
External beam or stereotactic body radiotherapy alone
06
Bisphosphonates or denosumab for prevention
07
Rehabilitation and bladder management

Which Department to Visit?

You can visit our Onkoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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You can make an appointment with our specialists or contact us for your concerns.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.