1 / 30

Spinal Cord Compression

Spinal Cord Compression. Carol S. Viele RN MS OCN Clinical Nurse Specialist Heme - Onc -BMT University of California San Francisco Associate Clinical Professor Dept of Physiological Nursing UCSF School of Nursing. Objectives.

nikkos
Download Presentation

Spinal Cord Compression

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Spinal Cord Compression Carol S. Viele RN MS OCN Clinical Nurse Specialist Heme-Onc-BMT University of California San Francisco Associate Clinical Professor Dept of Physiological Nursing UCSF School of Nursing

  2. Objectives • At the completion of this presentation the participant will be able to: • Describe the most common cancers associated with cord compression • Identify at least 2 symptoms associated with cord compression • Describe the most appropriate nursing interventions for cord compression

  3. Definition/Frequency • A mass effect from the tumor with associated edema which results in ischemia and neural damage to the spinal cord • 10% of all patients with cancer will develop this complication

  4. Occurrence • The most common source of cord compression is metastasis to the epidural space with or without bony involvement • Tumors can also through the reach the epidural space by direct extension through the intervertebral foramen • Some tumors occur in the cord itself

  5. Etiology • Tumor types • Breast, (Number 1 in women) • Lung • Kidney • Myeloma • Prostate • Melanoma • Gastrointestinal tumors • Lynphoma

  6. Level of Involvement • Cervical area 10% • Thoracic area 70% • Lumbosacral 20%

  7. Symptoms • Back pain is usually the first symptom • 95% of patients with a cord compression experience back pain • Pain will precede other symptoms by weeks to months • Early cord compression may be asymptomatic

  8. Manifestations • Pain • Localized • Radicular • Severity • Position changes • Cough • Weightbearing • Valsalva maneuver

  9. Manifestations • Weakness 75-85% • May progress rapidly • Bilateral • Corresponds to the level of cord involvemnent • Spasticity • Hyperreflexia • Abnormal stretch reflexes • Extensor plantar response

  10. Manifestations • Sensory loss • Bowel dysfunction • Bladder dysfunction • Impotence

  11. Diagnosis • Thorough physical examination • Palpation • Gentle percussion over bony areas • Neurologic exam • Laboratory data – Increased alkaline phosphatase may indicate bony involvement

  12. Diagnosis • Radiographs- may reveal erosion of the pedicle, • Lytic lesions of the vertebral body • Collapse of the vertebral body • Bone scan- 20% of scans reveal lesions missed on plain films • CT • Used to determine extent of tumor

  13. Diagnosis • MRI ( Tool of choice) • Able to determine prevertebral, vertebral, extradural, intradural, extramedullary and intramedullary lesions • Provides better anatomic visualization with sagittal and axial images of the spinal cord • Fine needle aspiration • May provide tissue confirmation

  14. Treatment • Criteria: • Primary tumor type • Level of myelopathy • Degree of spinal block • Potential for neurologic reversibility

  15. Treatment • Surgery • Radical resection if an a candidate • Complete block • Single lesion where complete removal is possible • Diagnosis is uncertain • Mild deficits • New data supports surgery over treatment with RT if patient is a good surgical candidate

  16. Treatment • Radiation therapy • If not a surgical candidate • Incomplete block • Severe deficits • Relapse in area of prior radiation if short survival is expected

  17. Treatment Radiation- often initiated as an emergency if not a surgical candidate • Therapy • Treatment field extends 1-2 vertebral bodies above and below level of compression • 3000-4000 cGy over 2-4 weeks • 2/3 of patients remain stable or improve • 65-75% achieve pain relief

  18. Treatment • Steroids • Dexamethasone • Bolus IV 10 mg • Oral 4-6 mg q 6 hours for 2 days then a slow taper • 25% of patients with cord compression require maintenance to maintain neurologic function • Steroid related side effects may occur • Hyperglycemia • GI bleeding • Psychosis

  19. Treatment • Chemotherapy • May be given in highly sensitive tumors • Always given with other modalities

  20. Outcome • Pretreatment ambulatory ability is the main determinant of post treatment ambulatory ability • 90% of patients ambulatory before therapy are after • Only 10% of paraplegics become ambulatory after therapy

  21. Prognosis • Median survival is 6 months if patient presents as a paraplegic • 50% of patients who walk in with a cord compression are alive at 1 year • If patient was ambulatory prior to RT survival is 8-10 months

  22. Recurrent Disease • Options • If RT given may be a surgical candidate if survival of > 12 months predicted • Repeat RT • Risks of repeat RT • Radiation myelopathy • Collateral damage

  23. Nursing Interventions • Thorough assessment and early MD/Provider notification of changes in • Pain • Sensory function • Motor function • Urinary function • Bowel function

  24. Nursing Interventions • Maintenance of functional status • Bowel program • Bladder program • Skin care • Rehabilitation services • PT • OT

  25. Nursing Interventions • Education • Patient • Family • Significant others • Care givers

  26. Nursing Interventions • Emotional support • Decrease anxiety • Referrals • Social worker • Psychologists • Psychiatrist • Chaplain

  27. Nursing Interventions • Referrals • Care coordination • Case manager • Home care • Rehabilitation center • Skilled nursing facility • Hospice

  28. References • Schulmeister, L., Gatlin, C.,( 2008) Spinal cord compression in Oncology Nursing Secrets, Gates, R. and Fink, R. (eds) Hanley and Belfus, Philadelphia, 546-550 • Quinn, J., De Angelis, L.(2000) “Neurologic emergencies in the cancer patient”, SeminOncol, 27: 311- 321 • Tan, S. Recognition and Treatment of Oncologic Emergencies (2002), Journal of InfusionNursing,25:3, 182-188

  29. References • www.uptodate.com, Spinal Cord Compression, Accessed 7/9/09

More Related