Spinal cord compression

Spinal cord disease represents a major cause of morbidity and suffering in cancer patients. Prevention or minimization of neurologic deficits depends on an understanding of early symptoms, clinical course, and treatment options. Early diagnosis is crucial, as current treatments usually arrest the course of the disease but much less commonly restore lost neurologic func-tion. This article will review the epidemiology, pathophysiology, symptoma-tology, diagnosis, and management of the causes of spinal cord dysfunction directly related to cancer. It will briefly discuss myelopathies related to para-neoplasia and treatment complications. Epidural spinal cord compression Spinal cord or cauda equina dysfunction resulting from tumor growth in the spinal epidural space is commonly referred to as epidural spinal cord compression (ESCC). In some ways, spinal epidural metastasis (SEM) may be a better term, as it encompasses the phenomena of root, cauda equina, and minor degrees of thecal sac compression SEM/ESCC is the most com-mon cause of spinal cord dysfunction in cancer patients, and will receive the bulk of attention in this article. Epidemiology Although careful, contemporary population-based studies are unavailable, the best evidence suggests that 5 % of patients dying of cancer have suffered ESCC [1]. With more than 500,000 Americans succumbing to cancer yearly, there are likely to be more than 25,000 cases of ESCC yearly in the Unite