1 Dana-Farber Cancer Institute, Boston, MA.
2 Brigham and Women's Hospital, Boston, MA.
J Clin Oncol. 2019 Jan 1;37(1):61-71. doi: 10.1200/JCO.2018.78.1211. Epub 2018 Nov 5.
Metastatic spinal cord compression (MSCC) can be a catastrophic manifestation of advanced cancer that causes immobilizing pain and significant neurologic impairment. Oncologists can protect their patients by having a high index of suspicion for MSCC when patients present with new or worsening back pain before motor, sensory, bowel, or bladder deficits develop. We provide an updated, evidence-based narrative review of the presentation, diagnosis, and treatment of MSCC.
This narrative review was conducted by searching MEDLINE and Cochrane Database of Systematic Reviews for relevant literature on the presentation, diagnosis, and treatment of patients with MSCC. The article addresses the key elements of MSCC management germane to the medical oncologist, with special attention given to pain and symptom management, decision making with regard to surgery and radiation therapy, the importance of rehabilitative care, and the value of a multidisciplinary approach.
Magnetic resonance imaging of the entire spine is recommended for the diagnosis of MSCC. Treatment includes glucocorticoid therapy, pain management, radiation therapy with or without surgery, and specialized rehabilitation. When formulating a treatment plan, clinicians should consider the patient's care goals and psychosocial needs.
Prompt diagnosis and treatment of MSCC can reduce pain and prevent irreversible functional loss. Regular collaboration among multidisciplinary providers may streamline care and enhance achievement of treatment goals.
转移性脊髓压迫症（MSCC）是晚期癌症的一种灾难性表现，可导致固定性疼痛和严重的神经功能障碍。当患者出现新的或加重的背痛，且尚未出现运动、感觉、肠道或膀胱功能障碍时，肿瘤学家通过保持对 MSCC 的高度怀疑，可以保护其患者。我们提供了关于 MSCC 的表现、诊断和治疗的最新循证叙述性综述。
通过搜索 MEDLINE 和 Cochrane 系统评价数据库中有关 MSCC 患者表现、诊断和治疗的相关文献，进行了本次叙述性综述。本文涉及与肿瘤内科医生相关的 MSCC 管理的关键要素，特别关注疼痛和症状管理、手术和放疗决策、康复护理的重要性以及多学科方法的价值。
建议对 MSCC 进行全脊柱磁共振成像诊断。治疗包括糖皮质激素治疗、疼痛管理、有或无手术的放疗，以及专门的康复治疗。在制定治疗计划时，临床医生应考虑患者的护理目标和心理社会需求。
及时诊断和治疗 MSCC 可以减轻疼痛并防止不可逆转的功能丧失。多学科提供者之间的定期协作可以简化护理并增强治疗目标的实现。
