Palliative Care Emergencies: Malignant Spinal Cord Compression
Malignant Spinal Cord Compression (MSSC) is considered a medical emergency!
Early detection and treatment are essential to prevent permanent loss of function.
Signs and Symptoms:
- Back pain at level of compression is the most common presenting symptom: can be localized at first and progress to radiating band-like pain
- worse when lying flat, sneezing or coughing
- improved with sitting or standing
- sense of weakness, heaviness or stiffness of extremities below compression and/or falls
- numbness, tingling of affected limbs
- urinary and/or bowel function changes
Intervention & Treatment:
- The patients’ condition, goals for care, and the potential for therapy success will define both the urgency and nature of the interventions undertaken.
- Immediate treatments may include: surgery, high doses of corticosteroids, and/or palliative radiation to decrease pain and preserve function
Management:
- Identify patients at risk
- Know the signs and symptoms
- Contact physician immediately if you suspect MSCC
- Provide emotional support
MSSC:
- Compression of the thecal sac at the level of the spinal cord or the cauda equine (lumbar and sacral roots which descend below the distal tip of the vertebral column)
- Occurs in 5 to 10% of all cancer presentations, with over 85% of cases result from a tumor directly compressing the spinal cord May occur as a result of the tumor interrupting the cords’ vascular supply or due to vertebral collapse or compression which leads to entrapment of nerves
- More commonly associated with metastatic disease from tumors of the breast, lungs, prostate, kidney and lymphoma
References: 1. Ferrell, B.R. & Coyle, N. (2006). Textbook of Palliative Nursing (2nd Ed.). New York, NY: Oxford University Press Inc. 2. Abrahm, J. (2004). Assessment and treatment of malignant spinal cord compression. The Journal of Supportive Oncology. 2(5), 377-388.
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