70 years old male presented in Emergency with 3 weeks history of constant back pain associated with weight loss. The pain was notably worse at night and aggravated by movement, progressively worsening since the previous night. On examination, mid-spinal tenderness was noted on palpation, and there was a 3/5 power loss that developed over last 2 hours. PSA was >100 ng/dl hence it was diagnosed as de novo Metastatic Prostate cancer.
IMAGING:
MRI whole spine was requested as per Cord compression protocol and thoracic spine revealed significant following findings:
Sagittal T2 Image: at the level of D7 – D9, prominent extra osseous paravertebral and epidural soft tissue tumor extension causing significant narrowing of the thecal sac. Extensive osseous metastases.
Cerebrospinal Fluid (CSF): complete CSF effacement
Cord Edema: High signal intensity in the cord indicated edema secondary to compression.
Learning Points
• Metastatic Prostate Cancer and cord Compression: can lead to pathological fractures, causing spinal cord compression. Old age, male and persistent back pain with neurological symptoms is a big red flag
• An MRI of the entire spine must be performed within 24 hours of presentation to assess if there are any other sites of cord compression that require medical attention
• Clinical Urgency : the time from clinical diagnosis to treatment should be within 24 hours. High-dose corticosteroids, such as dexamethasone, are initiated to reduce edema and alleviate symptoms.
• Multidisciplinary Approach: A prompt neurosurgical and radiation oncology consultation is crucial for devising a comprehensive treatment plan & to ensures timely intervention to prevent irreversible neurological damage.
• Management plan is finalized based on Spine stability, tumor type, Radiation sensitivity, Grade of tumor, modality of treatment available
Reference: doi: 10.3171/2010.3.SPINE09459.
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