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Cord Compression

Epidemiology
5-10% of general cancer population develops SCC

Pathophysiology
Metastatic or local cancer causes:

  • Compressive indentation
  • Displacement
  • Encasement of spinal cord

These processes cause:

  • Edema
  • Inflammation
  • Mechanical compression
  • Vascular damage and impairment of oxygenation

Clinical Presentation

  • Local pain or stiffness
  • Gradually worsening back pain
  • Radicular pain
  • May worsen with recumbent position
  • Leg weakness, paresthesia
  • Bowel or bladder disturbances

Diagnosis

  • Imaging
    • MRI
  • Procedural
    • LP is relatively contraindicated
    • Post-void residual

Treatment

  • Steroids
    • Dexamethasone 4-100 mg q6h
  • Radiation
    • Cord compression from an epidural tumor is one of the few emergencies in radiation oncology
  • Neurosurgical evaluation
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