Assessment and management of patients with metastatic spinal cord compression

A multidisciplinary review

Andrew J. Lawton, Kathleen A. Lee, Andrea L Cheville, Marco L. Ferrone, Dirk Rades, Tracy A. Balboni, Janet L. Abrahm

Research output: Contribution to journalReview article

Abstract

PURPOSE Metastatic spinal cord compression (MSCC) can be a catastrophic manifestation of advanced cancer that causes immobilizing pain and significant neurologic impairment. Oncologists can protect their patients by having a high index of suspicion for MSCC when patients present with new or worsening back pain before motor, sensory, bowel, or bladder deficits develop. We provide an updated, evidence-based narrative review of the presentation, diagnosis, and treatment of MSCC. METHODS This narrative review was conducted by searching MEDLINE and Cochrane Database of Systematic Reviews for relevant literature on the presentation, diagnosis, and treatment of patients with MSCC. The article addresses the key elements of MSCC management germane to the medical oncologist, with special attention given to pain and symptom management, decision making with regard to surgery and radiation therapy, the importance of rehabilitative care, and the value of a multidisciplinary approach. RESULTS Magnetic resonance imaging of the entire spine is recommended for the diagnosis of MSCC. Treatment includes glucocorticoid therapy, pain management, radiation therapy with or without surgery, and specialized rehabilitation. When formulating a treatment plan, clinicians should consider the patient’s care goals and psychosocial needs. CONCLUSION Prompt diagnosis and treatment of MSCC can reduce pain and prevent irreversible functional loss. Regular collaboration among multidisciplinary providers may streamline care and enhance achievement of treatment goals.

Original languageEnglish (US)
Pages (from-to)61-71
Number of pages11
JournalJournal of Clinical Oncology
Volume37
Issue number1
DOIs
StatePublished - Jan 1 2019

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Spinal Cord Compression
Pain Management
Therapeutics
Radiotherapy
Pain
Back Pain
MEDLINE
Nervous System
Glucocorticoids
Decision Making
Patient Care
Urinary Bladder
Spine
Rehabilitation
Magnetic Resonance Imaging
Databases

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Assessment and management of patients with metastatic spinal cord compression : A multidisciplinary review. / Lawton, Andrew J.; Lee, Kathleen A.; Cheville, Andrea L; Ferrone, Marco L.; Rades, Dirk; Balboni, Tracy A.; Abrahm, Janet L.

In: Journal of Clinical Oncology, Vol. 37, No. 1, 01.01.2019, p. 61-71.

Research output: Contribution to journalReview article

Lawton, Andrew J. ; Lee, Kathleen A. ; Cheville, Andrea L ; Ferrone, Marco L. ; Rades, Dirk ; Balboni, Tracy A. ; Abrahm, Janet L. / Assessment and management of patients with metastatic spinal cord compression : A multidisciplinary review. In: Journal of Clinical Oncology. 2019 ; Vol. 37, No. 1. pp. 61-71.
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