Oncologic Emergencies: Spinal Cord Compression

Spinal cord compression is a condition where the spinal cord is compressed by the surrounding bone fragments from a vertebral fracture, a tumor, abscess, ruptured intervertebral disc or other condition. Spinal cord compression may result from tumor, lymphomas or intervertebral collapse, and this can lead to permanent neurologic impairment, progressively, may be associated to morbidity and mortality. About 70% of compressions occur at the thoracic level, 20% in the lumbosacral level, and 10% in the cervical region. Metastatic cancers (breast, lung, kidney, prostate, myeloma, lymphoma) and related bone erosion are associated with this condition.

Manifestations

The following presentations are exhibited during oncologic emergencies in spinal cord compression:

1.  Local inflammation, edema, venous stasis and impaired blood supply to nervous tissues
2. Local or radicular pain along the dermatomal areas innervated by affected nerve root
3. Subtle weakness to flaccid paralysis
4. Pain exacerbated by movement, coughing, sneezing, or Valsalva maneuver
5. Bladder or bowel dysfunction depending on level of compression (Above S2: overflow incontinence, from S3 to S5: flaccid sphincter tone and bowel incontinence)
6. Neurologic dysfunction, motor and sensory deficits: numbness, tingling, feelings of coldness in affected area, inability to detect vibration, loss of positional sense)

Diagnosis

To verify the presence of this condition (spinal cord compression), the following assessment and diagnostic tools are used:

• Percussion tenderness at level of compression
• Abnormal reflexes
• Sensory and motor abnormalities
• MRI
• Myelogram
•  Spinal cord x-rays
• Bone scans
• CT scan

Management

The following regimen are the medical and nursing management to treat oncologic emergencies of spinal cord injuries:

1. Radiation therapy to reduce tumor size as ordered and as indicated
2. Corticosteroid therapy to decrease inflammation and swelling as ordered
3. Surgery if symptoms progress despite radiation or if vertebral fracture leads to additional nerve damage as indicated
4. Chemotherapy as adjuvant to radiation therapy for patients with lymphoma or small cell lung cancer as indicated
5. Perform ongoing assessment of neurologic function to identify existing and progressing dysfunction
6. Pharmacologic and non-pharmacologic measure for pain control (oncologic conditions are usually associated with pain)
7. Prevent complications of immobility from pain and decreased functions (thromboplebitis, skin breakdown, urinary stasis, decreased clearance of pulmonary secretions)
8. Assist patients in doing ROM exercises in collaboration with physical and occupational therapists to maintain muscle tone
9. Institute intermittent urinary catheterization and bowel training programs for bladder or bowel dysfunction of patients with such condition
10. Provide encouragement and support to patient and family coping with pain and altered functioning, lifestyle, roles and independence.

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