Assessing suspected spinal cord compression - A multidisciplinary outcomesanalysis of 342 episodes

The object of this work was to evaluate the assessment and document the out comes of cancer patients with suspected spinal cord compression (SCC). In a retrospective cohort study of 342 episodes of suspected SCC in cancer pati ents evaluated by computed tomography (CT) of the spine, a multidisciplinar y team of neurologists, radiologists, and oncologists assessed the impact o f varying the anatomical criterion for SCC and including new SCC diagnosed shortly after definitive radiographical imaging. We developed a logistic re gression model to identify independent clinical predictors of SCC, includin g the natural history of the underlying cancer as well as neurological and radiological risk factors. Management of suspected SCC infrequently involve d neurology consultation (21% of episodes). The frequency of SCC increased more than four-fold when the definition was expanded to include epidural ca ncer rather than spinal cord displacement only (36% vs 8%), and 90-day clin ical follow-up identified few new lesions not evident on definitive imaging studies. Clinical information about the course of cancer (documentation an d duration of metastatic cancer) added independent predictive information t o that yielded by neurological assessment and prior imaging studies in a mu ltiple regression model. The a priori predicted risk of SCC, which ranged f rom 4% to 87% in this study, may vary enough to affect treatment strategies , although our population may have excluded very-low-risk patients. Consist ent anatomical definitions of SCC, clinical follow-up of definitive imaging studies and the addition of information on the natural history of cancer t o traditional neurological and radiographical evaluation may all improve cl inical assessment of suspected SCC in cancer patients.