Compression of the cord or cauda equina by tumour, causing irreversible neurological deficit if untreated.
Clinical features
- • Progressive back pain worse on lying flat or coughing
- • Band-like radicular pain
- • Leg weakness, sensory level
- • Bladder/bowel dysfunction (late)
Investigations
- • Whole-spine MRI within 24 h (immediately if neurological signs)
- • Search for a primary if unknown
Management
- • Dexamethasone 16 mg PO with PPI immediately
- • Flat bed rest with log-rolling until stability assessed
- • Discuss with oncology/spinal surgery within 24 h
- • Radiotherapy or surgical decompression
- • Analgesia and VTE prophylaxis
Clinical pearls
- • Ambulatory status at treatment is the strongest predictor of walking afterwards — treat before weakness develops
Educational — verify locally.
