Several key areas must be considered in the diagnosis and management
of spinal cord compression. Because the outcome can be devastating,
a diagnosis must be made early and treatment initiated promptly.
Although any malignancy can metastasize to the spine, clinicians should
be aware that this occurs more commonly in certain diseases, ie, lung
cancer, breast cancer, prostate cancer, and myeloma. The current algorithm
for early diagnosis of spinal cord compression involves neurologic
assessment and magnetic resonance imaging of the entire spine.
Treatment generally consists of intravenous dexamethasone followed
by oral dosing. Depending on the extent of the metastases, symptoms
may also be managed with nonnarcotic pain medicines, anti-inflammatory
medications, and/or bisphosphonates, with local radiation administered
as needed. Surgery has often led to destabilization of the spine.