Background and objective Malignant Spinal Cord Compression (MSCC) is one of the most important and critical medical emergency, especially in oncologic patients. It is defined as a compression that involves the dural sac and its contents, due to primary tumor or to secondary causes as pathological fractures. The aim of this study is to define early symptoms of MSCC and to provide physical therapists the necessary indications in differential diagnosis of Low Back Pain. Methods We searched electronic databases, MEDLINE, PEDro and Google Scholar. Two reviewers independently reviewed the list of potentially eligible studies in literature from 2000 until 2015. We included studies regarding cord compression in an adult population, due to a primary tumor or a secondary cause, localized in the thoracic spine. Results The research in the databases identified 142 articles. 67 were excluded because duplicated and 32 because of the title and the abstract, yielding a total of 43 articles, of which 25 with full text availability. 14 cross references were added for a total number of 39 articles finally included. Discussion Oncologic patients are more incline to develop MSCC but it can appear also as first presentation in asymptomatic subjects. The primary tumors that are more incline to develop MSCC are breast, prostatic and pulmonary cancers. Clinical manifestations of MSCC are characterized by pain localized in the lumbar spine, with VAS 8/10, aggravating by laying down supine, coughing, sneezing, bending and often identified by the patient as worsening, more frequently defined as sharp and shooting. The presentation of motor, sensitive and neurological deficits represents malignancy in evolution. Conclusions Early presentations of MSCC has been identifying and reported as clinical manifestations that provide the elements to conduct a clinical reasoning that leads to a differential diagnosis of low back pain; for these reasons it is necessary to recognize early signs and symptoms and refer the patient to a clinician that can treat this medical emergency as soon as possible.
Malignant Cord Compression in the thoraco-lumbar spine. Early signs and symptoms in the differential diagnosis of low back pain
Maselli F;
2016-01-01
Abstract
Background and objective Malignant Spinal Cord Compression (MSCC) is one of the most important and critical medical emergency, especially in oncologic patients. It is defined as a compression that involves the dural sac and its contents, due to primary tumor or to secondary causes as pathological fractures. The aim of this study is to define early symptoms of MSCC and to provide physical therapists the necessary indications in differential diagnosis of Low Back Pain. Methods We searched electronic databases, MEDLINE, PEDro and Google Scholar. Two reviewers independently reviewed the list of potentially eligible studies in literature from 2000 until 2015. We included studies regarding cord compression in an adult population, due to a primary tumor or a secondary cause, localized in the thoracic spine. Results The research in the databases identified 142 articles. 67 were excluded because duplicated and 32 because of the title and the abstract, yielding a total of 43 articles, of which 25 with full text availability. 14 cross references were added for a total number of 39 articles finally included. Discussion Oncologic patients are more incline to develop MSCC but it can appear also as first presentation in asymptomatic subjects. The primary tumors that are more incline to develop MSCC are breast, prostatic and pulmonary cancers. Clinical manifestations of MSCC are characterized by pain localized in the lumbar spine, with VAS 8/10, aggravating by laying down supine, coughing, sneezing, bending and often identified by the patient as worsening, more frequently defined as sharp and shooting. The presentation of motor, sensitive and neurological deficits represents malignancy in evolution. Conclusions Early presentations of MSCC has been identifying and reported as clinical manifestations that provide the elements to conduct a clinical reasoning that leads to a differential diagnosis of low back pain; for these reasons it is necessary to recognize early signs and symptoms and refer the patient to a clinician that can treat this medical emergency as soon as possible.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
