Kompresija hrbtenjače Spinal cord compression

Abstract

Kompresija hrbtenjače je zaplet rakave bolezni, ki redko ogroža bolnikovo življenje, če pa je ne odkrijemo, lahko že v nekaj urah vodi do nepopravljive okvare hrbtenjače s trajno paralizo.
Do kompresije hrbtenjače največkrat pride pri bolnikih z zasevki v hrbtenici, redkeje je posledica neposrednega vraščanja mehkotkivne tumorske mase v hrbtenični kanal. Do tega zapleta najpogosteje pride pri bolnikih z rakom pljuč, dojke, prostate, ščitnice, ledvice in s plazmocitomom. Bolnik kot prve težave navaja bolečine v hrbtenici, temu se pridružijo nevrološki izpadi.
Nivo kompresije hrbtenjače določimo z nevrološkim pregledom. Od diagnostičnih metod je na prvem mestu rentgensko slikanje, ki pa nam pokaže le skeletne nepravilnosti, zato je za opredelitev kompresije hrbtenjače nujna MRI.
Pri grozeči kompresiji hrbtenjače moramo ukrepati takoj. Bolniku svetujemo mirovanje, predpišemo mu analgetike in glukokortikoide. Izbira zdravljenja je odvisna od narave bolezni, obsega prizadetosti hrbteničnega kanala in bolnikovega splošnega stanja. Obsega kirurško zdravljenje v kombinaciji z obsevanjem in sistemskim zdravljenjem ali pa le obsevanje skupaj s sistemskim zdravljenjem ali brez njega. V vsakem primeru je pri sumu, da gre za kompresijo hrbtenjače, pomembno, da zdravljenje začnemo čim prej.

Abstract (Eng)

Spinal cord compression is a complication of cancer that is usually not immediately life-threatening, but can lead to significant morbidity in a different way.
The mechanisms by which tumors can compress the spinal cord are hematogenous spread of tumor cells to the vertebra, or rarely, by direct extension of paraspinal tumors into the spine. Such compression is predominantly due to metastatic spread of the lung, breast, prostate, thyroid, kidney cancer or multiple myeloma. The most common presentation of spinal cord compression is back pain that is followed by neurological impairment.
The level of compression should be determined by physical examination. A standard x-ray is generally ordered first, but it shows only bony lesions. However, MRI is the imaging technique of choice for suspected spinal cord compression.
Spinal cord compression needs urgent treatment. Patient has to be prescribed analgetics and glucocorticoids and rest is advised. The choice of treatment depends on primary cancer type, degree of spinal cord damage and general performance status of the patient. Surgery in combination with radiotherapy and systemic therapy is treatment of choice in some cases, but radiotherapy alone or in combination with systemic therapy is sometimes an option. In any case, it is important to start the treatment as soon as possible.