Posted: November 11, 2018

The early diagnosis of spinal cord compression can lead to preservation of quality of life in the face of progressive metastatic cancer.  A trueism is that if you don’t consider spinal cord compression (SCC)n you won’t diagnose it.  Now comes a timely review article published in the Journal of Clinical Oncology from the Dana Farber Cancer Institute and Brigham and Women’s Hospital.  Click here for the article.  What is new in this entity, which has been recognized for a long time as a major clinical problem?  Answer: the aggressive use of MRI scanning when suspecting SCC.  Some other important take-home messages are that SCC can be the first evidence of metastatic cancer in someone thought to be without distant metastases.  Multiple myeloma, an uncommon disease, accounts for 11% of all cases in their meta-analysis — a number way out of proportion to its incidence.  The other point they make is that new-onset back pain should raise the possibility of early SCC.  Management has not changed in recent years, and this review is no exception to this.

Dr. Stark comments, “When I teach medical students and residents, I tell them: when a cancer patient develops urinary retention, don’t call the urologist.  Call the neurologist.”  The same index of suspicion should be operational for new onset numbness or weakness.  If you don’t consider the diagnosis, you are resigning your patients to a wheelchair for the rest of their lives.