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At least 19 recordsLinked to original sources
PubMed2005

Epidural spinal cord compression.

Spinal cord compression from epidural metastases (epidural spinal cord compression, ESCC) is the most common neurological complication of cancer after brain metastases. Extradural compression represents 97% of spinal cord metastatic lesions. ESCC usually occurs in patients with disseminated disease. The most common tumours associated with ESCC are lung and breast cancers, followed by lymphoma, myeloma, prostate cancer and sarcoma. ESCC represents a medical emergency because delayed treatment can be responsible for irreversible deficits, such as paralysis and loss of sphincter control. Patients with ESCC require a multidisciplinary diagnostic and therapeutic approach. Clinical suspect is radiologically detected for confirmation. The median expected survival time from diagnosis usually ranges from 3 to 6 months. The nature of the primary tumour and the degree of the neurological deficit are the most important factors affecting survival. The lack of prospective randomized trials makes the optimal treatment of ESCC controversial and the decision is to be tailored to the individual. Treatment options include: bed rest, administration of corticosteroids, surgery followed by radiation therapy, radiotherapy alone and, to a limited extent, chemotherapy and hormonal therapy.

Epidural Neoplasms↗
PubMedDate not supplied

Nursing care of the patient with spinal cord compression.

Spinal cord compression (SCC) is a common oncologic emergency that can profoundly affect the remainder of the patient's life. SCC develops when pressure is exerted on the spinal cord by a tumor or by a collapsed vertebral body that has been replaced by cancer. When the condition is diagnosed and treated early, the patient may maintain ambulatory status; however, when the diagnosis is made late and neurologic compromise has occurred already, there is minimal expectation that impaired functions will return. SCC is treated with dexamethasone and radiation therapy, and surgery occasionally is performed. Nursing care, an integral component in the management of this challenging condition, may be as simple as educating the at-risk patient about the signs and symptoms of SCC or as complex as meeting the many needs of the paraplegic patient. This article reviews the etiology and clinical presentation of SCC as well as assessment, treatment, and nursing care related to the condition.

Dexamethasone↗
PubMed1983

Metastatic spinal cord compression.

Spinal cord compression from metastatic cancer is a medical emergency. Prompt intervention affords the best chance for successful recovery, while delay may result in devastating neurologic impairment. In the appropriate clinical setting, emergency myelography should be done to confirm the diagnosis of metastatic disease. Dexamethasone should then be started, followed by immediate radiation therapy or surgical decompression.

Dexamethasone↗
PubMedDate not supplied

Assessment and treatment of patients with malignant spinal cord compression.

Spinal cord compression is a complication of malignancy that affects the quality of life of 12,700 new patients each year and disrupts the lives of the families striving to care for them. Compression can be prevented by early diagnosis, which requires a high index of suspicion on the part of patients, their families, and their clinicians. Disability arising from delays is associated with shortened patient survival. Magnetic resonance imaging is the gold standard for diagnosis and is needed in any cancer patient presenting with new back pain, whether or not plain films or bone scans show metastases. Symptomatic therapy addresses pain, constipation, spinal instability, and the psychological and social consequences of the associated disability. High-dose corticosteroids are recommended unless they are contraindicated or the patient is ambulatory and asymptomatic while receiving radiation therapy. Evidence-based guidelines recommend radiation therapy for most patients. Short courses of irradiation and reirradiation may be associated with less toxicity than previously thought. Initial surgery is recommended for patients without a previous cancer diagnosis or with a remote cancer, unstable spine or bony cord compression, or inability to receive further irradiation. New surgical data suggest that patients with irradiation-resistant tumors and a single site of compression may have improved function with initial surgery and reconstruction followed by irradiation,compared with irradiation alone.

Adrenal Cortex Hormones↗
PubMed2002

Progressive changes in neurofilament proteins and growth-associated protein-43 immunoreactivities at the site of cervical spinal cord compression in spinal hyperostotic mice.

STUDY DESIGN: Immunohistochemical examination of the expression and localization of neurofilament (NF) proteins and growth-associated protein (GAP)-43 in spinal hyperostotic (twy/twy) mice with progressive compression of the cervical spinal cord. OBJECTIVE: To determine the biologic functions of NF proteins and GAP-43 in the mouse cervical spinal cord during chronic mechanical compression. SUMMARY OF BACKGROUND DATA: The pathologic and repair process in the chronically compressed spinal cord are understood poorly. The present authors hypothesized that there existed an increased expression of NF proteins and GAP-43 in twy/twy mice during the lengthy period of spinal cord compression, which resembles compressive myelopathy. METHODS: The cervical spinal cords of 54 twy mice (aged 8 weeks [n = 18], 14 weeks [n = 18], and 20 weeks [n = 18]) and 18 control animals were examined histologically. Using appropriate antibodies, sections were also stained immunohistochemically for NF proteins and GAP-43. RESULTS: Separation of the myelin sheath from the axon and axonal swelling with deformation were detected in the anterior and lateral funiculi of the spinalcords of 20-week-old twy/twy mice. No such changes were noted in 8-week-old twy mice. In twy/twy mice aged 8 and 14 weeks with mild-to-moderate compression, weak immunoreactivities (mainly in the white matter) for NF proteins and GAP-43 were noted; however, in 20-week-old twy/twy mice, these axons stained strongly positive and immunoreactive swollen axons were present. The relative area of GAP-43 immunoreactive axons gradually increased between 8 and 20 weeks in each column, particularly in the anterior and lateral funiculi in the contralateral side of compression. CONCLUSIONS: The results showed that the expression of NF proteins and GAP-43 in the white matter increased proportionally with the magnitude of spinal cord compression, and indicated the possible involvement of GAP-43 in both axonal degeneration and repair processes in the chronically compressed spinal cord.

Aging↗
PubMed1996

Spinal epidural non-Hodgkin's lymphoma: case reports of three patients presenting with spinal cord compression.

Spinal epidural non-Hodgkin's lymphoma is an uncommon lesion. In this report, we describe three patients with a clinical picture of acute spinal cord compression as the first presentation of malignant lymphoma. The diagnosis was not suspected pre-operatively, and plain radiographs of the spine were either normal or not specific. Neuroimaging showed evidence of extradural soft tissue mass crossing multiple vertebral segments. In the light of these radiological findings, non-Hodgkin's lymphoma should be a diagnostic consideration in the older patient without prior history of malignancy who presents with a prodrome of back pain followed by spinal cord compression.

Aged↗
PubMedDate not supplied

Management of metastatic spinal cord compression.

Metastatic spinal cord compression, diagnosed in 3-7% of cancer patients, is one of the most dreaded complications of metastatic cancer. It is an oncologic emergency, which must be diagnosed early and treated promptly to achieve the best results and avoid progressive pain, paralysis, sensory loss and sphincter incontinence. Patients who are ambulatory at the time of the diagnosis have a higher probability of obtaining good response to treatment and a longer survival. In clinical practice, back pain accompanies metastatic spinal cord compression in most cases, even in patients with no neurologic deficits. Magnetic resonance imaging is the best tool for diagnosing metastatic spinal cord compression and is able to identify spinal cord compression in 32-35% patients with back pain, bone metastases and normal neurologic examination. Moreover, magnetic resonance imaging gives the extension of the lesion, can diagnose other unsuspected clinical metastatic spinal cord compression sites, and is useful for the radiation oncologist in defining the target volume. Radiotherapy is the treatment of choice in most cases, whereas surgery is advised only in selected patients (ie, if stabilization is necessary, if radiotherapy has already been given in the same area, when vertebral body collapse causes bone impingement on the cord or nerve roots, when there are diagnostic doubts, or when computed tomography-guided percutaneous vertebral biopsy cannot be performed). Laminectomy should be abandoned in favor of more aggressive surgery (ie, posterior, anterior, and/or lateral approach, tumor mass resection, and stabilization of the spine). Generally, radiotherapy must be administered 7-10 days after surgery. The optimal radiation schedule has not been defined. However, as recently suggested by some clinical trials, even the hypofractionated radiotherapy regimens are effective and can be used without increasing radiation-induced myelopathy. Moderate doses of dexamethasone should be used in the early phases of therapy. After radiotherapy, spinal recurrence is generally found in sites different from the first compression area. A close post-treatment follow-up is suggested using clinical parameters (pain, motor and sphincter function), and magnetic resonance imaging should be performed only when a second metastatic spinal cord compression and/or myelopathy are clinically suspected.

Algorithms↗
PubMedDate not supplied

Nontraumatic spinal cord compression.

Nontraumatic spinal cord compression can have very dramatic clinical presentations with rapid onset of symptoms and quickly ensuing paralysis. The manifestations may be much more subtle. This text will discuss the four most common causes of myelopathy, including spinal canal hemorrhage, spinal abscess, compression by tumor, and skeletal disease. Compressive lesions to the spinal cord from other than these etiologies are rare.

Abscess↗
PubMedDate not supplied

Diagnosis and treatment of malignant spinal cord compression.

Malignant spinal cord compression occurs in up to 10 per cent of people with cancer, and advances in treatments may increase its incidence as patients live longer. Nurses have an important role in all aspects of care, including early detection. Prompt treatment significantly improves patients' chances of avoiding permanent disability. However, the condition is characteristic of advanced cancer and therefore is in itself an indicator of poor prognosis.

Communication↗
PubMed2003

Malignant spinal cord compression.

Malignant spinal cord compression is one of the most dreaded complications of cancer. If untreated, it can lead to worsening neurologic function culminating in paralysis and sphincter incontinence. The most challenging aspect in the management of this complication is early diagnosis because the single most important factor determining outcome is the level of neurologic function at initiation of therapy. Magnetic resonance imaging is the diagnostic modality of choice. Steroids have a proven role in the treatment. Radiation therapy has been the standard of care, with surgery reserved for special cases. A recent randomized trial has proven that in appropriately selected patients initial surgery, followed by radiation, provides better functional and neurologic outcome compared to radiation alone and will likely become the standard of care in the future. Newer modalities, such as transarterial embolization and extracranial stereotactic radiosurgery, are emerging and may be considered in appropriate cases if available.

Antineoplastic Agents, Hormonal↗
PubMed1990

Experimental neoplastic spinal cord compression: effect of anti-inflammatory agents and glutamate receptor antagonists on vascular permeability.

It has been demonstrated in paraplegic rats harboring an epidural neoplasm that an antiedema effect can be achieved by in vivo treatment with either steroidal or nonsteroidal anti-inflammatory agents or by glutamate receptor antagonists. The effect of these treatments on vascular permeability of the normal and compressed spinal cord was quantitated by the Evans blue dye technique. Tumor-free and tumor-bearing rats were assigned randomly for treatment as follows: 0.5 ml of saline or three doses at 12-hour intervals of either dexamethasone (5 mg/kg), methylprednisolone (30 mg/kg), indomethacin (5 mg/kg every 24 hours), or a single dose of either ketamine (110 mg/kg) or MK-801 (3 mg/kg). Treatment was given at the onset of paraplegia, and the animals were killed after 30 hours. In tumor-bearing rats in the early symptomatic stage, extravasation of Evans blue dye was 4.8 times greater than that of the normal cord (P less than 0.001) and at the onset of paraplegia it was 9.9 times greater (P less than 0.0006). Glucocorticoids and indomethacin reduced dye extravasation in paraplegic animals (P less than 0.01 and P less than 0.003, respectively), but the decreased permeability induced by ketamine and MK-801 did not reach the level of significance. In tumor-free control animals permeability was not changed by administration of either glucocorticoids or indomethacin but was significantly reduced by ketamine or MK-801 (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMedDate not supplied

Management of malignant spinal cord compression.

Malignant spinal cord compression is a relatively uncommon but serious condition that needs to be treated with urgency to prevent paralysis. Formal guidelines on procedures to be followed if malignant cord compression is suspected, and increased education of patients, nurses, and doctors, could help avoid some delays in treatment.

Diagnosis, Differential↗
PubMed2004

Epidural Spinal Cord Compression.

Epidural spinal cord compression is a neurologic emergency requiring immediate attention. The therapy instituted depends on several factors, including the patient's condition at the time of presentation, the nature of the underlying malignancy, the extent of systemic disease burden, and patient prognosis. The most essential aspect of treatment is the establishment of the diagnosis. If one suspects malignant cord compression an emergency, magnetic resonance imaging of the entire spinal axis is indicated. If magnetic resonance imaging is unavailable, post-myelographic computed tomography is an alternative. However, treatment should not be delayed until imaging is performed, particularly if neurologic deficits are present. Pain should be adequately addressed and opioids administered if necessary. Steroids should be given. If significant neurologic deficits are present, a high-dose corticosteroid bolus, followed by standing doses, should be given. However, if pain is the predominant symptom, steroids can be withheld pending immediate imaging or lower doses can be given without a bolus. Neurosurgical consultation should be obtained, and surgery should be considered if the patient's condition permits. This is particularly true if spinal instability or significant kyphosis is present or compression is secondary to bony fragments. Other indications include patients with limited systemic disease burden in whom better survival is predicted and possibly those with radioresistant tumors. The type of surgery performed should be tailored to the distribution of disease within the spine and accessibility through anterior body cavities. Radiation therapy, an effective noninvasive treatment that can be delivered quickly and safely, is an appropriate option as well. This is particularly true in radio-responsive tumors, such as myeloma and lymphoma, in which surgery may be avoided entirely. Chemotherapy may play a role as adjuvant therapy in some tumors.

Journal Article↗
PubMed1990

Experimental neoplastic spinal cord compression: effect of ketamine and MK-801 on edema and prostaglandins.

Excitotoxin-induced neural tissue damage is mediated through specific receptors. We studied the in vivo effect of two selective N-methyl-D-aspartate receptor antagonists on the compressed spinal cord segments of rats harboring a thoracolumbar epidural tumor. The effect of a single intramuscular treatment with either MK-801 (3 mg/kg) or ketamine (110 mg/kg) given at the onset of paraplegia was evaluated 30 hours later. In saline-treated control animals, significant increases in water content, prostaglandin E2, and 6-keto-prostaglandin F1 alpha were evident. Treatment with either agent resulted in a normal water content in the compressed segments but had no effect on prostaglandin synthesis. Evaluation of the effect of treatment on the course of the disease required dose reduction by 45% for ketamine and by 30% for MK-801, to avoid the excessive sedative effect. Treatment was started at the first appearance of neurological dysfunction (Grade 1) and continued to paraplegia (Grade 5). The mean time interval between Grades 1 and 5 was 2.1 +/- 0.3 days in saline-treated control animals, and it was not significantly altered by either ketamine or MK-801. Our study indicates that in the end stage of epidural compression, when ischemia is present, excitotoxins probably participate in the evolution of a cytotoxic edema. It is suggested that treatment initiated at the onset of paraplegia may still reduce the cytotoxic edema, but its potential clinical value requires further investigations.

Analysis of Variance↗
PubMed2006

Clinical approach to metastatic epidural spinal cord compression.

Metastatic epidural spinal cord compression (MESCC) is a devastating complication of cancer that occurs when cancer metastasizes to the spine and then secondarily compresses the spinal cord. It is a relatively common complication of cancer and. in the United States, more than 20,000 cases of MESCC are diagnosed annually. If left untreated, virtually 100% of these patients would become paraplegic; therefore, it is considered a true medical emergency and immediate intervention is required. Even with aggressive therapy, results can often be unsatisfactory. Although most patients with MESCC have limited survival, up to one third will survive beyond one year. Thus. it is essential to consider aggressive therapy to preserve or improve the quality of life and prevent paraplegia.

Clinical Trials as Topic↗