Spinal Cord Compression (SCC)
Spinal cord compression (SCC) is a true oncologic emergency as delays in diagnosis can cause severe, irreversible neurologic compromise, decline in functional status, and impaired quality of life. SCC affects roughly 3% to 5% of all patients with cancer. The majority of cases result from spine metastases with extension into the epidural space. It is the second most frequent neurologic complication of cancer after brain metastases. The median overall survival of patients with SCC ranges from 3 to 16 months and most die of systemic tumor progression.
*Bethesda Handbook of Oncology
Causes
Although all cancers capable of hematogenous spread can cause malignant SCC, the most common underlying cancer diagnoses associated with this complication are:
- breast
- prostate
- lung
- multiple myeloma
- lymphoma
Hematogenous seeding of tumor to the vertebral bodies is the most common cause of spinal metastases, followed by direct extension and cerebrospinal fluid spread.
Nearly 66% of the cases with SCC have involvement of the thoracic spine and 20% have involvement of the lumbar spine. Colon and prostate malignancies more commonly spread to the lumbosacral spine, while lung and breast cancers frequently affect the thoracic spine. The cervical and sacral spines are rarely involved (less than 10% for each region).
The median time interval between cancer diagnosis and manifestation of SCC is approximately 6 to 12.5 months. Malignant SCC is rarely the primary manifestation of a malignancy. (but with the difficulty in accessing a primary care physician, this is more common in 2024)
*Bethesda Handbook of Oncology
