Malignant Spinal Cord Compression: An Overview

Abstract

Malignant spinal cord compression (MSCC) occurs when malignant cells grow in, or near to the spinal cord, and compresses the thecal sac and nerve roots. These results in swelling and decrease in the blood flow to spinal cord and causes increase in the venous permeability and eventually interstitial edema. Interstitial edema compresses blood in small arterioles and arrest of capillary flow, resulting in ischemia. Ischemia impairs cord functions resulting in weakness and sensory impairment Any type of cancer can spread to the bones of the spine, which may lead to spinal cord compression. However, it is more commonly seen in hematological malignancies and in solid neoplasms such as breast, lung and prostate cancer. Consistent anatomical definitions of MSCC, clinical follow-up of definitive imaging studies and the addition of information on the natural history of cancer to traditional neurological and radiographic evaluation may all improve clinical assessment of suspected SCC in cancer patients. However, early detection and urgent treatment of malignant spinal cord compression is the only way to prevent paraplegia and severe neurological deficit.