Skip to main content

Advertisement

SpringerLink
Log in

Spinal cord compression in cancer patients: Review of diagnosis and treatment

  • Published:
Current Oncology Reports Aims and scope Submit manuscript

Abstract

Spinal cord compression (SCC) is a well-known complication in cancer patients, with an enormous potential impact on quality of life. In most cases, treatment is palliative, but a prompt diagnosis and immediate treatment is essential to preserving neurological function. Whereas steroids and radiation have been the mainstay of therapy for many years, the role and timing of surgery has remained controversial. However, class I evidence now exists to support the benefit of pre-irradiation surgical decompression in a carefully selected subpopulation of patients with SCC. A multidisciplinary approach is required to maximize the therapeutic and functional outcome of these patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Perrin RG, Laperriere NJ, Loblaw A, Laxton AW: Spinal axis metastases. In Cancer in the Nervous System. Edited by Levin VA. New York: Oxford University Press; 2002:341–361.

    Google Scholar 

  2. Bilsky MH, Lis E, Raizer J, et al.: The diagnosis and treatment of metastatic spinal tumor. Oncologist 1999, 4:459–469.

    PubMed  CAS  Google Scholar 

  3. Klimo P, Jr, Thompson CJ, Kestle JR, Schmidt MH: A meta-analysis of surgery versus conventional radiotherapy for the treatment of metastatic spinal epidural disease. Neuro-oncology 2005, 7:64–76.

    Article  PubMed  Google Scholar 

  4. Schiff D: Spinal cord compression. Neurol Clin 2003, 21:67–86.

    Article  PubMed  Google Scholar 

  5. Gilbert RW, Kim JH, Posner JB: Epidural spinal cord compression from metastatic tumor: diagnosis and treatment. Ann Neurol 1978, 3:40–51.

    Article  PubMed  CAS  Google Scholar 

  6. DeAngelis LM: Leukemia and lymphoma metastases. In Cancer in the Nervous System. Edited by Levin VA. New York: Oxford University Press; 2002:362–373.

    Google Scholar 

  7. Grier J, Batchelor T: Metastatic neurologic complications of non-Hodgkin’s lymphoma. Curr Oncol Rep 2005, 7:55–60.

    Article  PubMed  Google Scholar 

  8. Antunes NL: Acute neurologic complications in children with systemic cancer. J Child Neurol 2000, 15:705–716.

    PubMed  CAS  Google Scholar 

  9. Quinn JA, DeAngelis LM: Neurologic emergencies in the cancer patient. Semin Oncol 2000, 27:311–321.

    PubMed  CAS  Google Scholar 

  10. Klimo P, Jr, Kestle JR, Schmidt MH: Treatment of metastatic spinal epidural disease: a review of the literature. Neurosurg Focus 2003, 15:E1.

    PubMed  Google Scholar 

  11. Abrahm JL: Assessment and treatment of patients with malignant spinal cord compression. J Support Oncol 2004, 2:377–401.

    PubMed  Google Scholar 

  12. Patchell RA, Tibbs PA, Regine WF, et al.: Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet 2005, 366:643–648.

    Article  PubMed  Google Scholar 

  13. Helweg-Larsen S, Sorensen PS, Kreiner S: Prognostic factors in metastatic spinal cord compression: a prospective study using multivariate analysis of variables influencing survival and gait function in 153 patients. Int J Radiat Oncol Biol Phys 2000, 46:1163–1169.

    PubMed  CAS  Google Scholar 

  14. Hainline B, Tuszynski MH, Posner JB: Ataxia in epidural spinal cord compression. Neurology 1992, 42:2193–2195.

    PubMed  CAS  Google Scholar 

  15. Colletti PM, Siegel HJ, Woo MY, et al.: The impact on treatment planning of MRI of the spine in patients suspected of vertebral metastasis: an efficacy study. Comput Med Imaging Graph 1996, 20:159–162.

    Article  PubMed  CAS  Google Scholar 

  16. Loblaw DA, Perry J, Chambers A, Laperriere NJ: 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.

    Article  PubMed  Google Scholar 

  17. Plotkin SR, Wen PY: Neurologic complications of cancer therapy. Neurol Clin 2003, 21:279–318.

    Article  PubMed  Google Scholar 

  18. Bataller L, Dalmau J: Paraneoplastic neurologic syndromes. Neurol Clin 2003, 21:221–247.

    Article  PubMed  Google Scholar 

  19. Fogel GR, Cunningham PY, Esses SI: Spinal epidural lipomatosis: case reports, literature review and meta-analysis. Spine J 2005, 5:202–211.

    Article  PubMed  Google Scholar 

  20. Koch CA, Doppman JL, Patronas NJ, et al.: Do glucocorticoids cause spinal epidural lipomatosis? When endocrinology and spinal surgery meet. Trends Endocrinol Metab 2000, 11:86–90.

    Article  PubMed  CAS  Google Scholar 

  21. Resnick IB, Gomori JM, Kiselgoff D, et al.: Spinal epidural lipomatosis following haploidentical allogeneic bone marrow transplantation for non-Hodgkin lymphoma. Clin Transplant 2004, 18:762–765.

    Article  PubMed  Google Scholar 

  22. Chamberlain MC: Leukemia and the nervous system. Curr Oncol Rep 2005, 7:66–73.

    Article  PubMed  Google Scholar 

  23. Ayerbe J, Quiñones D, Prieto E, Sousa P: Spinal subarachnoid hematoma after lumbar puncture in a patient with leukemia: report of a case and review of the literature [in Spanish]. Neurocirugia (Astur) 2005, 16:447–452.

    CAS  Google Scholar 

  24. Penas-Prado M, Sepulveda Sanchez JM, Martin Garcia H, Ruiz Morales J: Neurological emergencies in oncologic patients [in Spanish]. In Neurological emergencies [in Spanish]. Edited by Gonzalez de la Aleja Tejera J, Rodriguez Pena-Marin M, Sepulveda Sanchez JM. Madrid: Jarpyo; 2006:369–390.

    Google Scholar 

  25. Greenberg HS, Kim JH, Posner JB: Epidural spinal cord compression from metastatic tumor: results with a new treatment protocol. Ann Neurol 1980, 8:361–366.

    Article  PubMed  CAS  Google Scholar 

  26. Sorensen S, Helweg-Larsen S, Mouridsen H, Hansen HH: Effect of high-dose dexamethasone in carcinomatous metastatic spinal cord compression treated with radiotherapy: a randomised trial. Eur J Cancer 1994, 30A:22–27.

    Article  PubMed  CAS  Google Scholar 

  27. Vecht CJ, Haaxma-Reiche H, van Putten WL, et al.: Initial bolus of conventional versus high-dose dexamethasone in metastatic spinal cord compression. Neurology 1989, 39:1255–1257.

    PubMed  CAS  Google Scholar 

  28. Heimdal K, Hirschberg H, Slettebo H, et al.: High incidence of serious side effects of high-dose dexamethasone treatment in patients with epidural spinal cord compression. J Neurooncol 1992, 12:141–144.

    Article  PubMed  CAS  Google Scholar 

  29. Maranzano E, Latini P, Beneventi S, et al.: Radiotherapy without steroids in selected metastatic spinal cord compression patients: a phase II trial. Am J Clin Oncol 1996, 19:179–183.

    Article  PubMed  CAS  Google Scholar 

  30. Young RF, Post EM, King GA: Treatment of spinal epidural metastases. Randomized prospective comparison of laminectomy and radiotherapy. J Neurosurg 1980, 53:741–748.

    PubMed  CAS  Google Scholar 

  31. Ghogawala Z, Mansfield FL, Borges LF: Spinal radiation before surgical decompression adversely affects outcomes of surgery for symptomatic metastatic spinal cord compression. Spine 2001, 26:818–824.

    Article  PubMed  CAS  Google Scholar 

  32. Witham TF, Khavkin YA, Gallia GL, et al.: Surgery insight: current management of epidural spinal cord compression from metastatic spine disease. Nat Clin Pract Neurol 2006, 2:87–94.

    Article  PubMed  Google Scholar 

  33. Schirmer CM, Malek AM, Kwan ES, et al.: Preoperative embolization of hypervascular spinal metastases using percutaneous direct injection with n-butyl cyanoacrylate: technical case report. Neurosurgery 2006, 59:E431–E432.

    Article  PubMed  Google Scholar 

  34. Guzman R, Dubach-Schwizer S, Heini P, et al.: Preoperative transarterial embolization of vertebral metastases. Eur Spine J 2005, 14:263–268.

    Article  PubMed  Google Scholar 

  35. O’Reilly GV, Kleefield J, Klein LA, et al.: Embolization of solitary spinal metastases from renal cell carcinoma: alternative therapy for spinal cord or nerve root compression. Surg Neurol 1989, 31:268–271.

    Article  PubMed  CAS  Google Scholar 

  36. Fourney DR, Schomer DF, Nader R, et al.: Percutaneous vertebroplasty and kyphoplasty for painful vertebral body fractures in cancer patients. J Neurosurg 2003, 98:21–30.

    Article  PubMed  Google Scholar 

  37. Lo SS, Chang EL, Yamada Y, et al.: Stereotactic radiosurgery and radiation therapy for spinal tumors. Expert Rev Neurother 2007, 7:85–93.

    Article  PubMed  Google Scholar 

  38. Wong ET, Portlock CS, O’Brien JP, DeAngelis LM: Chemosensitive epidural spinal cord disease in non-Hodgkin’s lymphoma. Neurology 1996, 46:1543–1547.

    PubMed  CAS  Google Scholar 

  39. Higgins SA, Peschel RE: Hodgkin’s disease with spinal cord compression. A case report and a review of the literature. Cancer 1995, 75:94–98.

    Article  PubMed  CAS  Google Scholar 

  40. Burch PA, Grossman SA: Treatment of epidural cord compressions from Hodgkin’s disease with chemotherapy. A report of two cases and a review of the literature. Am J Med 1988, 84:555–558.

    Article  PubMed  CAS  Google Scholar 

  41. Matsubara H, Watanabe K, Sakai H, et al.: Rapid improvement of paraplegia caused by epidural involvements of Burkitt’s lymphoma with chemotherapy. Spine 2004, 29:E4–E6.

    Article  PubMed  Google Scholar 

  42. Kataoka A, Shimizu K, Matsumoto T, et al.: Epidural spinal cord compression as an initial symptom in childhood acute lymphoblastic leukemia: rapid decompression by local irradiation and systemic chemotherapy. Pediatr Hematol Oncol 1995, 12:179–184.

    Article  PubMed  CAS  Google Scholar 

  43. Gale J, Mead GM, Simmonds PD: Management of spinal cord and cauda equina compression secondary to epidural metastatic disease in adults with malignant germ cell tumours. Clin Oncol (R Coll Radiol) 2002, 14:481–490.

    CAS  Google Scholar 

  44. Cooper K, Bajorin D, Shapiro W, et al.: Decompression of epidural metastases from germ cell tumors with chemotherapy. J Neurooncol 1990, 8:275–280.

    Article  PubMed  CAS  Google Scholar 

  45. Bernardi B, Pianca C, Pistamiglio P, et al.: Neuroblastoma with symptomatic spinal cord compression at diagnosis: treatment and results with 76 cases. J Clin Oncol 2001, 19:183–190.

    PubMed  Google Scholar 

  46. Aviles A, Fernandez R, Gonzalez JL, et al.: Spinal cord compression as a primary manifestation of aggressive malignant lymphomas: long-term analysis of treatments with radiotherapy, chemotherapy or combined therapy. Leuk Lymphoma 2002, 43:355–359.

    Article  PubMed  Google Scholar 

  47. Rogers MJ, Watts DJ, Russell RG: Overview of bisphosphonates. Cancer 1997, 80:1652–1660.

    Article  PubMed  CAS  Google Scholar 

  48. Pavlakis N, Schmidt RL, Stockler M: Bisphosphonates for breast cancer. Cochrane Database Syst Rev 2005, (3):CD003474.

  49. Yuen KK, Shelley M, Sze WM, et al.: Bisphosphonates for advanced prostate cancer. Cochrane Database Syst Rev 2006, (4):CD006250.

  50. Rosen LS, Gordon D, Tchekmedyian NS, et al.: Long-term efficacy and safety of zoledronic acid in the treatment of skeletal metastases in patients with non-small cell lung carcinoma and other solid tumors: a randomized, phase III, double-blind, placebo-controlled trial. Cancer 2004, 100:2613–2621.

    Article  PubMed  CAS  Google Scholar 

  51. Rosen LS, Gordon D, Kaminski M, et al.: Long-term efficacy and safety of zoledronic acid compared with pamidronate disodium in the treatment of skeletal complications in patients with advanced multiple myeloma or breast carcinoma: a randomized, double-blind, multicenter, comparative trial. Cancer 2003, 98:1735–1744.

    Article  PubMed  CAS  Google Scholar 

  52. Stubblefield MD, Bilsky MH: Barriers to rehabilitation of the neurosurgical spine cancer patient. J Surg Oncol 2007, 95:419–426.

    Article  PubMed  Google Scholar 

  53. Abrahm JL: Management of pain and spinal cord compression in patients with advanced cancer. Ann Intern Med 1999, 131:37–46.

    PubMed  CAS  Google Scholar 

  54. McLinton A, Hutchison C: Malignant spinal cord compression: a retrospective audit of clinical practice at a UK regional cancer center. Br J Cancer 2006, 94:486–491.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neuro-Oncology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Box 431, Houston, TX, 77030, USA

    Marta Penas-Prado

Authors
  1. Marta Penas-Prado
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Monica E. Loghin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marta Penas-Prado.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Penas-Prado, M., Loghin, M.E. Spinal cord compression in cancer patients: Review of diagnosis and treatment. Curr Oncol Rep 10, 78–85 (2008). https://doi.org/10.1007/s11912-008-0012-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11912-008-0012-0

Keywords

Search

Navigation