Condition that results from processes causing compression or displacement of the arterial, venous, and cerebrospinal fluid spaces, as well as the spinal cord itself
Pathophysiology
Malignant deposits grow over time leading to gradual neurological deficits (often both sensory and motor)
In some cases spinal metastases can collapse vertebrae leading to sudden deficits
Clinical features
Back pain - severe, burning, shooting, radiation around abdomen
Pain worsening on coughing or straining
New difficulty walking or climbing stairs
Sensory impairment or altered sensation in the limbs
Bowel or bladder disturbance = late sign and poor prognosis
Investigations
Full neurological examination
Consider bladder scan
MRI full spine: not just at level of pain as can be multi-level disease
Management
Administration of dexamethasone: given at 16 mg daily in divided doses
Reduces oedema but can take days
Prescribe PPI with steroids and ensure blood glucose is monitored
Give earlier in the day as it is a stimulant
Pain is often severe - aggressive treatment with opiates and neuropathic analgesics +/- palliative care team referral
Definitive management: neurosurgery and/or radiotherapy depending on level of disease
Isolated bony metastases can be surgically resected and this can be followed by radiotherapy
Plasmacytomas are a classic example (myeloma subtype)
Radiotherapy for pain or control, does not usually last longer than 6 months