Does the patient want emergency management?
Is the patient still walking?
Is the patient suffering from severe back pain?
Does the patient already have established cord compression?
Does the patient have a short prognosis (e.g. week by week deterioration)?
Where suspicion of spinal cord compression is high, it is quickest to telephone the oncological team in the cancer centre where the patient has been managed, who can then coordinate the necessary scan and appropriate emergency treatment (Table 15.2).
| Indications for surgical decompression . | Indications for radiotherapy . |
|---|---|
• Uncertain cause—to obtain histology • Radiotherapy has not been effective or symptoms persist despite maximum radiotherapy • Radioresistant tumour, e.g. melanoma, sarcoma • Unstable spine • Major structural compression • Cervical cord lesion • Solitary vertebral metastasis | • Radiosensitive tumour • Multiple levels of compression • Unfit for major surgery • Patient choice |
| Indications for surgical decompression . | Indications for radiotherapy . |
|---|---|
• Uncertain cause—to obtain histology • Radiotherapy has not been effective or symptoms persist despite maximum radiotherapy • Radioresistant tumour, e.g. melanoma, sarcoma • Unstable spine • Major structural compression • Cervical cord lesion • Solitary vertebral metastasis | • Radiosensitive tumour • Multiple levels of compression • Unfit for major surgery • Patient choice |
Patients with spinal cord compression provide great challenges to the multidisciplinary team. These challenges include:
Mobility management (risk of venous thrombosis)
Skin management in a patient confined to bed (risk of pressure sores)
Bowel management
Urinary system management
Psychological management.
There is no consensus on the optimum time to start mobilizing patients diagnosed with cord compression. In general, if the spine is stable and the pain is relatively well controlled it would seem wise to introduce physiotherapy as soon as possible to maintain muscle tone and motor function. The occupational therapist will be crucial in helping with goal-setting and rehabilitative techniques.
Steroids are usually continued at high dose to start with, and then tailed off gradually and completely discontinued after some time (4–6 weeks), or to the lowest dose that maintains stability. Radiation-induced oedema may exacerbate symptoms and the dose of steroids may need to increase temporarily during treatment.
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