Case 101 - Cord compression

Summary

Imaging description

Compression of the spinal cord by an extrinsic mass such as tumor or abscess often constitutes a medical emergency [1]. One of the common causes for spinal cord compression is metastatic epidural spinal cord compression (MESCC), first described by Spiller in 1925 [2]. It requires rapid diagnosis and treatment to avoid permanent progressive pain, diminished quality of life, and paralysis culminating in death [1,3]. MESCC is discovered in 5–10% of cancer patients, with lung carcinoma (Fig. 101.1), prostate cancer, and breast carcinoma the most common causes, followed by non-Hodgkin’s lymphoma (Fig. 101.2), renal cell cancer, multiple myeloma (Fig. 101.3), and plasmacytoma (Fig. 101.4) [1,3,4]. In more than 85% of the patients, the cord compression is due to epidural growth of metastasis to vertebral bodies by hematogenous spread (Figs. 101.1D, 101.3D). The gradual compression can be precipitated in acute process by collapse of vertebral body (Fig. 101.4). In about 15% of patients, paravertebral tumor can grow directly into the spinal canal through an intervertebral foramen (Fig. 101.2D), leading to cord compression. This is more commonly seen in lymphomas (Fig. 101.2) and neuroblastomas [3].