Spinal cord compression

Bilateral orchiectomy, or removal of the testes, rapidly reduces circulating androgens to castrate levels (andro-stenedione less than 50 ng/mL, 1.7 nmol/L).15 However, many patients are not surgical candidates owing to their advanced age, and other patients find this procedure psychologically unacceptable.15 Orchiectomy is the preferred initial treatment in patients with impending spinal cord compression or ureteral obstruction. 

Since patients with spinal metastases generally are incurable, the primary goal of treatment of spinal cord compression is palliation. The most important prognostic factor for patients presenting with spinal cord compression is the underlying neurologic status. 

Although not typically life-threatening, spinal cord compression is a true oncologic emergency because delays in treatment by mere hours may lead to permanent neurologic dysfunction. It is therefore incumbent on practitioners to... 

Around 20,000 cancer patients experience spinal cord compression in the United States every year, most of which involves the thoracic spine (approximately 70%). Cancers that inherently metastasize to bone (e.g., breast, prostate, and lung) are the most frequent etiologies identified. Most spinal cord compression occurs in patients with a known malignancy however, 8% to 34% occurs as the initial presentation of cancer, especially in patients with non-Hodgkins lymphoma, multiple myeloma, and lung cancer.17... 

The spinal cord emerges from the brain stem at the base of the skull and terminates at the second lumbar vertebra. The thoracic spine is most vulnerable to cord compression because of natural kyphosis and because the width of the thoracic spinal canal is the smallest among the vertebrae. Most spinal cord compression is due to adjacent vertebral metastases that compress the spinal cord or from pathologic compression fracture of the vertebra. This results in significant edema and inflammation in the affected area. 

Surgery for spinal cord compression typically involves either laminectomy for posterior lesions or decompression with fixation. Surgery is the treatment of choice for the following patients (1) those with an unstable spine requiring... 

Pain management is also of critical importance in patients with spinal cord compression. While dexamethasone will provide some benefit, opioid analgesics also should be used and titrated rapidly to achieve adequate pain control. 

Prasad D, Schiff D. Malignant spinal-cord compression. Lancet Oncol 2005 6 15-24. 

Ureteral obstruction and spinal cord compression have been observed. An immediate orchiectomy may be necessary if these conditions occur. 

There are two major classes of pain medications, nonopioids and opioids. The nonopioids used to treat mild pain include agents such as acetaminophen, both steroid and nonsteroidal antiinflammatory drugs (NSAIDs), and acetylsalicylic acid. Anticonvulsants suppress neuronal firing and are also helpful in neuropathic pain. Antiinflammatory agents (e.g., NSAIDs or corticosteroids) may be particularly helpful when bony involvement occurs and are often used for low-intensity pain. Steroids decrease inflammatory edema and are useful in cases of nerve and spinal cord compression, lymphedema, visceral pain caused by organ enlargement, and bone pain. Finally, short-term corticosteroid therapy may also produce euphoria (thus ameliorating less severe depressions) as well as reverse anorexia. 

There have been repeated reports of epidural lipomatosis, which can lead to spinal cord compression (48,49) or spinal fracture (50) in one instance, the excised lipomata contained brown fat, a phenomenon that may prove to be not unusual in glucocorticoid-induced lipomata (SEDA-16, 451). 

Laroche F, Chemouilh R, Carlier P. Efficacy of conservative treatment in a patient with spinal cord compression due to corticosteroid-induced epidural lipomatosis. Rev Rheum (English Edn) 1993 30 729-31. 

TIRILAZAD MESYLATE IN CAT SPINAL CORD COMPRESSION INJURY... 

Anderson, D.K., Waters, T.R. and Means, E.D. (1988) Pretreatment with alpha tocopherol enhances neurologic recovery after spinal cord compression injury, J. Neurotrauma 6, 61-68. 

Embolism from thrombus within the cavity of an aneurysm is rare and is difficult to prove in cases where there maybe other potential sources of embolization. Intracranial aneurysms more commonly present with rupture and subarachnoid hemorrhage, whereas internal carotid artery aneurysms tend to cause pressure symptoms including a pulsatile and sometimes painful mass in the neck or pharynx, ipsilateral Horner s syndrome or compression of the lower cranial nerves. Extracranial vertebral artery aneurysms may cause pain in the neck and arm, a mass, spinal cord compression and upper limb ischemia (Catala et al. 1993). 

A Spinal cord compression from a herniated disc... 

Prostatic cancer is androgen-dependent and metastatic disease can be helped by orchidectomy, or by a gonadorelin analogue, e.g. buserelin, goserelin, leuprorelin or triptorelin. These cause a transient stimulation of luteinising hormone and thus testosterone release, before inhibition occurs some patients may experience exacerbation of tumour effects, e.g. bone pain, spinal cord compression. Where this can be anticipated, prior orchidectomy or antiandrogen treatment, e.g. with cyproterone or flutamide, is protective. 

North RB, Cutchis PN, Epstein JA, Long DM. Spinal cord compression complicating subarachnoid infusion of morphine case report and laboratory experience. Neurosurgery 1991 29(5) 778-84. 

Johnston MK, Harland SP. Spinal cord compression from precipitation of drug solute arouud au epidural catheter. Br J Neurosurg 1998 12(5) 445-7. 

Raphaelson MI, Stevens JC, Newman RP. Vincristine neuropathy with bowel aud bladder atony, mimicking spinal cord compression. Cancer Treat Rep 1983 67(6) 604-5. 

Transient increase in bone pain transient increase in tumour mass, resulting in ureteral obstruction and/or spinal cord compression in patients with metastatic prostate cancer hot flashes... 

Involvement of the spine usually occurs in the cervical vertebrae lumbar vertebral involvement is rare. Involvement of the first and second cervical vertebrae can lead to instability of this joint. Patients with this problem are at a greater risk for spinal cord compression, although this complication is rare. 

Antiandrogens are coadministered during initial therapy to decrease symptoms of tumor flare (bone pain, urinary tract obstruction, or spinal cord compression) associated with the initial increase in serum testosterone levels Administered as a subcutaneous injection of implanted pellets every 1-3 months... 

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