First Things First (assess & treat for the following)

• The vast majority of cases of tumor-induced paraplegia are from metastatic epidural spinal cord compression (MESCC).
  • Cord compression (CC) is a relatively common CNS complication of cancer.
    • 1/3 of all cancer pts get secondary spinal tumors; 3rd behind liver & lung.
    • 5% of pts who die of cancer get MESCC.
    • 18K new cases in North America each yr.
  • Metastatic presentations are 20 times more common than primary tumors of the cord.
    • Initial manifestation in 10% of cancer pts.
    • Most frequent primaries: breast, lung, prostate, hematopoietic system, renal
    • 95% of spinal mets are extradural.
      • Hematogenous spread to vertebral bodies.
      • CC when spreads to epidural space.
      • Rare etiologies of MESCC: paraspinous extension, marrow replacement (myeloma), foraminal invasion (lymphoma).
      • Rare etiologies of tumor-induced paraplegia.
  • Intradural metastases (<5%) can be either within the cord (intramedullary) or extramedullary.
  • Primary spinal cord tumors (about 1/100,000) are very rare. Don’t usually present w/ paraplegia.
  • Anatomically possible though rare causes of tumor-induced paraplegia are midline cerebral lesions w/ bifrontal involvement. The motor areas of the lower extremities are located next to each other midline on the precentral gyrus.