Practice Easily Missed?

Metastatic spinal cord compression

BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d2402 (Published 27 April 2011) Cite this as: BMJ 2011;342:d2402
  1. Nasir A Quraishi, consultant spine surgeon 1,
  2. Claire Esler, consultant oncologist2
  1. 1Centre for Spine Studies and Surgery, Queen’s Medical Centre, Nottingham NG7 2UH, UK
  2. 2Department of Oncology, Leicester Royal Infirmary, Leicester, UK
  1. Correspondence to: N A Quraishi nasquraishi{at}hotmail.com
  • Accepted 22 February 2011

Metastatic spinal cord compression is defined radiographically as an epidural metastatic lesion causing true displacement of the spinal cord from its normal position in the spinal canal.1 It is an important source of morbidity (including paralysis and bowel and bladder disorders) in patients with systemic cancer.

Case scenario

A 58 year old woman presents to her general practitioner with a two month history of middle to low back pain. She has a history of breast carcinoma, diagnosed eight years previously and which was treated with a mastectomy and chemotherapy. She also describes pins and needles in both legs for the past three days. On examination, she has tenderness over the area of the T11 and T12 vertebrae and reduced power distally (T4 and T5) but intact bowel and bladder function. She is referred urgently to the metastatic cord compression coordinator, who organises magnetic resonance imaging, which shows cord compression by a mass at the T11 and T12 levels, thought to be caused by metastases.

How common is metastatic spinal cord compression?

  • Skeletal system metastases are the third most common metastases, after those of the pulmonary and hepatic systems2

  • Within the skeletal system, the spinal column is the most common site of metastases2

  • Metastatic cord compression is estimated to occur in 5-10% of patients with cancer (most commonly those with breast, prostate, and lung cancers) and in about 40% of patients who have pre-existing, non-spinal bone metastases3

  • Symptomatic metastatic spinal disease is expected to become more prevalent as survival rates for many common cancers improve

Why is metastatic spinal cord compression missed?

Low back pain is one of the most common complaints in primary care, with most cases being benign, self limiting, and not needing a specific diagnosis. The challenge in primary care is therefore to identify those cases where low back pain is caused by a serious spinal disease, such as malignancy. …

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