Occurs in approximately 3% of all patients with advanced cancer, most commonly those with breast, lung and prostate cancer. Less common cancers such as renal cell, lymphoma, myeloma, melanoma and sarcoma account for the majority of others. Usually caused by metastatic spread to a vertebral body or pedicle, although rarely can be due to direct invasion through the intervertebral foramina.
Common presenting signs and symptoms of spinal cord compression
Pain that is made worse by movement, straight leg raising and coughing. May be described as being ‘like a band’. May precede other symptoms by weeks or months.
Weakness in limbs that initially may be subtle. The patient may describe struggling to get up out of a chair, altered balance or legs giving way.
Altered sensation, often with a definable level on clinical examination. The patient may describe having heavy legs, feet that feel like cotton wool, tingling or altered bladder and/or bowel habit. The patient, until formally examined, may miss this. Disturbance of sphincter function occurs late. There may be painless bladder distension.
Reflexes will be absent at the level of the lesion and increased below the level of the lesion. The patient may have up going plantar reflexes. In some cases there is clonus.
The diagnosis is a clinical one based on history and examination. It needs to be considered in anyone who has gone off his or her legs. In the majority of cases plain X rays of the spine will show evidence of metastatic disease. However normal plain X rays of the spine do not exclude the diagnosis. MRI is the investigation of choice but management should start as soon as the diagnosis is suspected.
