Em basic- heme Onc Part 1- oncology Emergencies

Malignant Spinal Cord Compression

-Back pain in a patient with known or highly suspected cancer is a very worrisome chief complaint

-Pain is described as unremitting, worse at night or wakes from sleep, worse when supine (benign back pain usually better with rest and doesn’t wake from sleep)

-70% of malignant compressions occur in the thoracic spine

-If lumbar spine involved- may have symptoms of cauda equina

-Leg weakness

-Saddle (groin) anesthesia

-Bowel/bladder retention (early), bowel/bladder incontinence (late)

-Test of choice- MRI

-If MRI absolutely contraindicated- then CT with or without myelography

(catheter in spinal canal to deliver contrast)
PEARL: Even if patient only has lumbar symptoms, scan the thoracic spine as well because the mass can be up to 4 levels higher than the deficits or complaints
-Medications: Decadron 10mg IV

-Consults: Emergent consultation to radiation oncology for emergent radiation treatment to shrink tumor to limit loss of function, consider consult to spine surgery for tumor debulking