Spinal Cord Compression: An Obstructive Oncologic Emergency

Maryjo Osowski, RN, MSN, AOCN

Disclosures

Topics in Advanced Practice Nursing eJournal. 2002;2(4) 

In This Article

History

A thorough history and a complete physical examination are necessary to differentiate SCC from other conditions. The APN must ask about the location, radiation, and duration of the pain, as well as specific characteristics (burning or stabbing), severity of pain, and whether the pain is present at night.[10] It is important to ask the patient whether the pain is present when he or she is lying down, because SCC, unlike strain or old injury, causes pain that is unrelieved or increased in the recumbent position. It is also important to ask about the time of the pain, because early morning stiffness may indicate arthritis, and evening discomfort could indicate muscle strain or old injury.

The patient must be asked about the existence of other symptoms, such as muscle stiffness, feelings of heaviness, difficulty climbing stairs, and coordination problems.[2] Motor weakness is the second most common symptom of SCC, occurring in 80% of cases, and it can be present at the same time as sensory loss.[5] Sensory dysfunction is also present in SCC. Therefore, the APN must question the patient about the existence, location, and onset of numbness, tingling, or coolness in the arms, hands, fingers, legs, feet, toes, and trunk.

The patient should also be asked about constipation or urinary retention because these symptoms are early indicators of injury to the autonomic nerves. The presence of urinary and/or bowel incontinence indicates advancing autonomic involvement, and perianal numbness indicates cauda equina syndrome, a condition requiring immediate decompression.[2,10] Surgical intervention within 48 hours of the onset of symptoms generally improves sensory and motor deficits and urinary and rectal function.[11]

Cauda equina syndrome usually occurs as a result of a massive disc herniation in the lumbar region and should therefore be considered in the differential diagnosis.[11] Other conditions to consider include infections or epidural abscess, hematoma, or damage to the spinal cord from exposure to radiation, syrinx, and neoplastic meningitis.[3,10]

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