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Postoperative radiation is delivered within 2–3 weeks of surgical decompression. Emergency radiation therapy (usually 20 grays in 5 fractions, 30 grays in 10 fractions or 8 grays in 1 fraction) is the mainstay of treatment for malignant spinal cord compression. It is very effective as pain control and local disease control.
The spinal cord is a long, cylindrical anatomical structure that is located within the vertebral cavity. It runs from the foramen magnum of the skull to the conus medullaris at the lumbar spine. [1] Most symptoms from spinal tumors occur due to compression of the spinal cord as it plays a primary role in motor and sensory function. [13]
Once the spinal injury has occurred, one of two things may happen. Firstly, hemorrhaging within the spinal cord may cause compression, which damages the spinal cord even further. Another consequence of myelomalacia is improper circulation of blood to the area damaged, resulting in further damage to the spinal cord. [citation needed]
Spinal cord compression. About three percent of cancer patients experience spinal cord compression, usually from expansion of the vertebral body or pedicle due to metastasis, sometimes involving collapse of the vertebral body. Occasionally compression is caused by nonvertebral metastasis adjacent to the spinal cord.
Occasionally, surgery is necessary to control symptoms, such as spinal cord compression or bowel obstruction. This is referred to as palliative treatment. Surgery may be performed before or after other forms of treatment. Treatment before surgery is often described as neoadjuvant.
Bone metastases can cause severe pain, bone fractures, spinal cord compression, hypercalcemia, anemia, spinal instability, decreased mobility, and rapid degradation in the quality of life for patients. [7] [8] Patients have described the pain as a dull ache that grows worse over time, with intermittent periods of sharp, jagged pain. [3]
In advanced stages of prostate cancer, radiation is used to treat painful bone metastases or reduce spinal cord compression. Radiation therapy is also used after radical prostatectomy either for cancer recurrence or if multiple risk factors are found during surgery.
Cross-section of the spinal cord showing the dorsal column and the anterolateral spinothalamic tracts. Surgical cutting or destruction of peripheral or central nervous tissue is now rarely used in the treatment of pain. [43] Procedures include neurectomy, cordotomy, dorsal root entry zone lesioning, and cingulotomy.