Early detection and treatment of spinal cord compression

Several key areas must be considered in the diagnosis and management of spinal cord compression. Because the outcome can be devastating, a diagnosis must be made early and treatment initiated promptly. Although any malignancy can metastasize to the spine, clinicians should be aware that this occurs more commonly in certain diseases, i.e., lung cancer, breast cancer, prostate cancer, and myeloma. The current algorithm for early diagnosis of spinal cord compression involves neurologic assessment and magnetic resonance imaging of the entire spine. Treatment generally consists of intravenous dexamethasone followed by oral dosing. Depending on the extent of the metastases, symptoms may also be managed with nonnarcotic pain medicines, anti-inflammatory medications, and/or bisphosphonates, with local radiation administered as needed. Surgery has often led to destabilization of the spine.