Palliative Care Emergencies: Malignant Spinal Cord Compression

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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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