Spinal epidural metastases: a common problem for the primary care physician.
Spinal metastases are a common complication of cancer that should be managed quickly and aggressively. Most often from lung or breast cancer (or due to lymphoma), they usually seed from blood into vertebrae and extend into the epidural space. The most common presentation is pain and weakness, and the evolution can be rapid with paraplegia within days. Better prognosis is related to slower onset and pretreatment motor status, so spinal metastases are an emergency. Testing includes X-rays, neuroimaging, myelogram/CT and most recently MRI. Treatment is guided by the severity of neurological deficits, whether compression is by soft tissue or bone, and the presence of instability. A soft tissue mass with only mild to moderate deficits can be treated with radiation. Surgery is required for severely affected patients who are deteriorating rapidly with instability and bone in the canal. New approaches and fusion techniques facilitate decompression and stabilization.
McCallister
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Department of Neurosurgery, Robert C. Byrd Health Sciences Center of West Virginia University, Morgantown.
Kaufman
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HH
D015174:Epidural Neoplasms / Q000175:diagnosis / Q000503:physiopathology / Q000556:secondary* / Q000628:therapy; D006801:Humans