Compression of the dural sac and its contents (spinal cord and/or cauda equina) by an extradural tumor mass.
The minimum radiologic evidence for cord compression is indentation of the theca at the level of clinical features.
Symptoms and signs
Common symptoms and signs of MSCC include pain, radiculopathy, weakness, sensory changes, sphincter incontinence, and autonomic dysfunction. Delay in diagnosis of MSCC results in loss of mobility, bladder dysfunction, and decreased survival.
Magnetic resonance imaging (MRI) is the gold standard in detecting epidural metastatic disease and frank spinal cord compression.
Symptomatic therapy includes opioids, corticosteroids, and adjuvants; 85% of patients with malignant spinal cord compression receive radiation therapy. Selected patients with cancer with a single contiguous area of compression and a radioresistant tumor may be candidates for initial surgery followed by radiation therapy and rehabilitation.
Palliative care practitioners can provide expert symptom management and can help patients and their families begin to explore and cope with changes in self-image, independence, and roles in the family and community and, when appropriate, begin advance care planning.
Treatment for patients with MSCC should consider pretreatment ambulatory status, comorbidities, technical surgical factors, the presence of bony compression and spinal instability, potential surgical complications, potential RT reactions, and patient preferences.
See reference for more information.
Loblaw A, Perry J, Chambers A, Laperriere N. Systematic review of the diagnosis and management of malignant extradural spinal cord compression: The Cancer Care Ontario Practice Guidelines Initiative’s Neuro-Oncology Disease Site Group. J Clin Oncol 2005; 23:2028-2037. American Society of Oncology (ASCO) 2009.