Spinal Cord Compression:
Potentially leading to permanent neurologic impairment and associated morbidity and mortality, compression of the cord and its nerve roots may result from tumor, lymphomas, or intervertebral collapse.
The prognosis depends on the severity and rapidity of onset. About 70% of compressions occur at the thoracic level, 20% in the lumbosacral level, and 10% in the cervical region. Metastatic cancers (breast, lung, kidney, prostate, myeloma, lymphoma) and related bone erosion are associated with spinal cord compression.
• Local inflammation, edema, venous stasis, and impaired blood supply to nervous tissues
• Local or radicular pain along the dermatomal areas innervated by the affected nerve root (eg, thoracic radicular pain extends in a band around the chest or abdomen)
• Pain exacerbated by movement, coughing, sneezing, or the Valsalva maneuver
• Neurologic dysfunction, and related motor and sensory deficits (numbness, tingling, feelings of coldness in the affected area, inability to detect vibration, loss of positional sense)
• Motor loss ranging from subtle weakness to flaccid paralysis
• Bladder and/or bowel dysfunction depending on level of compression (above S2, overflow incontinence; from S3 to S5, flaccid sphincter tone and bowel incontinence)
• Percussion tenderness at the level of compression
• Abnormal reflexes
• Sensory and motor abnormalities
• MRI, myelogram, spinal cord x-rays, bone scans, and CT scan
• Radiation therapy to reduce tumor size to halt progression and corticosteroid therapy to decrease inflammation and swelling at the compression site
• Surgery only if symptoms progress despite radiation therapy or if vertebral fracture leads to additional nerve damage
• Chemotherapy as adjuvant to radiation therapy for patients with lymphoma or small cell lung cancer
• Note: Despite treatment, patients with poor neurologic function before treatment are less likely to regain complete motor and sensory function; patients who develop complete paralysis usually do not regain all neurologic function.
• Perform ongoing assessment of neurologic function to identify existing and progressing dysfunction.
• Control pain with pharmacologic and non pharmacologic measures.
• Prevent complications of immobility resulting from pain and decreased function (eg, skin breakdown, urinary stasis, thrombophlebitis, and decreased clearance of pulmonary secretions).
• Maintain muscle tone by assisting with range-ofmotion exercises in collaboration with physical and occupational therapists.
• Institute intermittent urinary catheterization and bowel training programs for patients with bladder or bowel dysfunction.
• Provide encouragement and support to patient and family coping with pain and altered functioning, lifestyle, roles, and independence.