Acute Medicine | Oncology | Acute back pain - malignant cord compression: Investigation and management

Acute Back Pain - Malignant Cord Compression: Investigation and Management
Session Overview
Description
This session considers the assessment, investigation and management of acute back pain, the causes of acute back pain and the specific management of spinal cord compression due to malignant disease.

Learning Objectives
By the end of this session you will be able to:

• Explain the causes of acute back pain
• State the epidemiology of acute back pain
• State the methods of investigation of acute back pain
• Describe the treatment of acute malignant cord compression

Metastatic spinal cord compression (MSCC) is a medical emergency. It should be considered in any patient with a history of malignancy who presents with acute or progressive back pain or neurological signs.

Although less severe diagnoses may be more likely in patients with cancer, MSCC can lead to profound disability if missed and, as such, should be actively ruled out.

Epidemiology

Approximately 5% of patients with malignancy will experience malignant spinal cord compression [1]. At greater risk are patients with cancers that more typically metastasise to, or involve, bone (prostate, breast, lung, non-Hodgkin lymphoma, multiple myeloma).

Some studies have suggested that up to 20% of cases of MSCC arise as the initial presentation of malignancy, so even patients without a history of malignancy should be assessed and investigated thoroughly [2].