Dexamethasone at doses ranging from 16 to 100 mg daily is most commonly used. The first therapeutic intervention in patients with suspected or documented cord compression should include the administration of high doses of intravenous glucocorticoids. Spinal magnetic resonance imaging (MRI) is used routinely to exclude the possibility of significant epidural disease, and it has almost entirely replaced other methods such as CT myelography and conventional myelography. However, a deficit on neurologic examination may be the only finding in patients who exhibit soft-tissue epidural metastasis in the paravertebral region. Most of these patients have abnormalities on bone scintigraphs and/or abnormal findings on radiography at the time of diagnosis. Epidural cord compressions arising from vertebral bodies account for the majority of spinal cord compressions less frequently they are associated with soft-tissue masses involving the paravertebral region. Early diagnosis and treatment of epidural metastasis is critical in preserving ambulation and bowel and bladder function and aids in the management of back pain ( Gabriel and Schiff, 2004 Grossman and Lossignol, 1990 ). In view of the propensity for prostate cancer to metastasize to the vertebrae and paravertebral regions, the incidence of epidural cord compression is particularly high in this disease. Such considerations become even more important when the painful areas affect extremities and weight-bearing sites.Įpidural metastasis is fairly common and is a potentially devastating complication of systemic cancer.
In general, it is also recommended that painful areas that are shown to be abnormal on bone scintigraphy should be evaluated with plain radiographs or CT imaging to exclude the presence of osteolytic lesions or pathological fractures. Focal bone pain in patients with CRPC can be well controlled using external-beam localized radiation therapy. The most common pain syndromes and their respective therapeutic considerations are summarized in Table 162.1. Prompt recognition of the various pain syndromes associated with this disease is critical to accomplish effective control of this devastating symptom. Cancer-related pain is undoubtedly the most debilitating symptom associated with advanced-stage metastatic prostatic carcinoma. Partin MD, PhD, in Campbell-Walsh-Wein Urology, 2021 Pain and Spinal Cord CompressionĪs in other disseminated malignancies, palliation of symptoms and maintenance of adequate quality of life represent the most important objectives in the management of advanced prostate cancer. As cord compression is eminently treatable, it should always be excluded before considering alternative possibilities.Īlan W.
In general, extradural lesions progress at a faster rate than intradural ones and in the former group motor, deficits usually appear before other forms of functional loss. Local tenderness may be present when pressure is applied over a spinous process long before more obvious structural changes occur. Back pain appearing for the first time in the middle-aged or elderly should never be disregarded because pain as a presenting symptom is especially common in malignant disease and may precede the appearance of the signs of cord compression by weeks or months. The disease of the vertebrae is associated with a deep-seated intolerable aching pain, usually localized to the segments affected and responding poorly to analgesics. Unfortunately, the relatively uncommon condition of spinal cord compression can often begin with the almost ubiquitous symptom of backache, particularly if the incipient obstruction is arising from elements outside the theca. This chapter discusses spinal cord compression that may evolve from disease or trauma of the vertebrae, prolapse of intervertebral discs, or lesions within the spinal canal such as tumor or infection. David Uttley, in Contemporary Neurology, 1984 Publisher Summary
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