What is Spinal Cord Compression?

The spinal cord is a long, thin, tubular bundle of nervous tissue and support cells that extends from the brain down through the vertebrae (bones of the back). These nerves allow you to move your arms and legs, they allow you to have reflexes and also to sense things, such as; the need to pass urine or move your bowels; the sense of touch, etc. Spinal cord compression is a problem that can occur in a proportion of individuals with lung cancer and is a medical emergency, as delayed diagnosis can lead to permanent disability. Spinal cord compression can occur at any time during the disease course, from initial presentation before a diagnosis of cancer to the terminal phase of advanced disease.

Causes

Malignant spinal cord compression occurs when cancer cells grow in, or near to, the spine and press on the spinal cord and nerves. This results in swelling and a reduction in the blood supply to the spinal cord and nerve roots. The symptoms of spinal cord compression are caused by the increasing pressure (compression) on the spinal cord and nerves.

Symptoms

·     Back pain - the first symptom is usually any unexplained back pain, which may be mild to begin with but becomes severe. The pain may feel like a 'band' around the chest or abdomen and can sometimes radiate over the lower back, into the buttocks or legs. Quite often this pain is worse when lying down and it may affect sleeping.

·     Numbness or pins and needles in toes and fingers, or over the buttocks.

·     A new feeling of being unsteady on your feet, having difficulty walking, or your legs giving way.

·     Problems passing urine - these may include difficulty controlling your bladder, passing very little urine or passing none at all.

·     Constipation or problems controlling your bowels

These symptoms can also be caused by a number of other conditions. It is very important to let your doctor know if you have any of these symptoms so that they can be investigated. The earlier spinal cord compression is diagnosed, the better the chances are of the treatment being effective.

Management

Taking a history of your symptoms and examining individuals may cause your doctor or nurse to suspect spinal cord compression, however, investigations have to be carried out to confirm this diagnosis. You may have to undergo an MRI scan (magnetic resonance imaging).

Treatment should be started as soon as possible after diagnosis. This is to prevent permanent damage to the spinal cord, which can result in paralysis. The choice of treatment depends on several factors including the type of cancer, the area of the spine affected and your general fitness. The most common treatment is radiotherapy, although occasionally surgery may be used . The aim of treatment is to shrink the tumour and relieve pressure on the nerves. Treatment usually involves a combination of the following:

Bed Rest - Your doctor will usually advise complete bed rest and at first you may need to lie flat on your back. This is to prevent any further damage to the spinal cord being caused by unnecessary movement. Your symptoms will be assessed by regular physical examination (of the nerves) this will help the doctors decide when you can start to get up and about again.

Steroids - High doses of a steroid called dexamethasone are usually started immediately if spinal cord compression is suspected. The steroid helps reduce pressure and swelling around the spinal cord, and can quickly relieve symptoms such as pain. The dose is gradually reduced over time and then stopped depending on the improvement of symptoms, and after starting other treatment such as radiotherapy and surgery.

Radiotherapy - Radiotherapy is the use of high-energy rays to destroy the cancer cells and is the most common way to treat spinal cord compression. It is usually used on its own, or occasionally alongside other treatments such as surgery. It is given by directing radiotherapy rays at the cancer from outside the body. Radiotherapy is usually given as a short course of treatment. This can range from one single treatment to one treatment a day for two weeks. Radiotherapy will be started as soon as possible after spinal cord compression is diagnosed.

Surgery- Surgery is only suitable for a small number of people to treat their spinal cord compression. This will depend on several factors, including the type of tumour, where it is situated and how unstable the spine may be. The aim of surgery is to remove as much of the tumour as possible and relieve pressure within the spinal canal.

Rehabilitation - if the spinal cord compression has affected an individual's ability to walk or move then the rehabilitation team will be working to improve functioning, the team will monitor progress to try to improve independence.

References

http://www.macmillan.org.uk/Cancerinformation/Livingwithandaftercancer/Symptomssideeffects/Othersymptomssideeffects/MSCC.aspx