Neoplastic myelopathies

Involvement of the spinal cord by cancer is seen in 5% to 10% of all patients with cancer. This article reviews disorders in which cancer results in spinal cord dysfunction.

Involvement of the spinal cord in patients with cancer occurs by either direct or indirect mechanisms. Direct mechanisms can be classified by involvement of the spinal cord in one of three anatomic compartments: parenchymal (intradural intramedullary), subarachnoid or CSF (intradural extramedullary), or epidural (extradural). Neoplastic parenchymal spinal cord disease may be either metastatic (intramedullary metastases) or a primary spinal cord tumor. Intradural extramedullary spinal cord disease occurs as a consequence of leptomeningeal metastases or primary tumors of this compartment, such as peripheral nerve sheath tumors and meningiomas. Extradural disease is mostly due to epidural spinal cord compression secondary to metastases. Indirect mechanisms of spinal cord disease associated with neoplasms, although less common, are predominantly a result of neurotoxic consequences of cancer treatment, including radiation injury (radiation myelitis) and chemotherapy injury as a consequence of intra-CSF chemotherapy. The spinal cord may be rarely injured in paraneoplastic neurologic disorders.

Neoplastic myelopathies are not infrequent. In patients with cancer who have symptoms and signs referable to the spinal cord, a high clinical suspicion of neoplastic disorders involving the spinal cord is required for ascertaining a diagnosis. Treatment is predominantly palliative but can provide a substantial benefit by preserving neurologic function and quality of life.