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

Physical Examination

Physical examination findings correspond to the location of the tumor, degree of cord impingement, and duration of involvement.[3] The APN should palpate the entire spine to determine whether there is any tenderness or pain. Tenderness is an early sign of SCC and thus may indicate beginning neurologic injury, the prompt treatment of which will result in complete recovery of function. Often the patient will complain of soreness or tenderness over the vertebral body with tumor involvement.

Having the patient walk heel to toe will establish whether there are any gait problems. Checking the patient's ability to move specific muscles in response to resistance by the examiner can rule out muscle weakness and paresis.[2] Pain that progresses down the patient's asymptomatic (or less symptomatic) leg when the leg is raised straight may suggest SCC.[3]

If cord compression is left untreated, weakness often develops, preceded or accompanied by sensory loss.[9] In a patient with a history of cancer, bilateral leg weakness that is noticeable with stair climbing, paresthesias in the legs, and bowel or bladder dysfunction are all red flags for SCC. Sensory function -- specifically, the ability to distinguish temperatures and feel vibration -- is evaluated using hot and cold tuning forks.[2] Pain recognition is assessed using dull and sharp tools.

A rectal examination should be performed to assess sphincter tone. Weak rectal sphincter tone is a late sign of SCC, signaling worsening injury to the nerve roots affected by the increasing compression of the spinal cord. If the patient has urinary complaints, the bladder is catheterized for postvoiding residual urine. Urinary volumes > 200 mL may suggest a neurogenic bladder. Once such autonomic symptoms appear, SCC usually progresses rapidly, and it may result in irreversible paralysis in hours to days if untreated.[9]

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