Common Metastatic Spinal Cord Compression (MSCC) and cauda equina exam questions for medical finals, OSCEs and MRCP PACES
Click on the the example questions below to reveal the answers
Question 1:
Where in the spinal column does the spinal cord end?
- Typically at the level of L1; below this the lumbosacral nerve roots float in CSF forming the cauda equina (horse’s tail).
Question 2:
What is the prognosis of cord compression?
- Median survival from presentation is 6 months.
- Median 3 months if nonambulatory at presentation.
- Median 9 months if ambulatory at presentation.
Question 3:
What signs predict good recovery?
- Ambulatory status at onset of treatment
- Tumour (highly radiosensitive cancers do better, e.g. lymphoma, myeloma, seminoma, breast, prostate)
- <14 days from motor symptoms to initiation of radiotherapy
Question 4:
Why is an MRI of only the affected part of the spine inadequate?
- Clinical signs are poor at localising the site of the lesion
- Metastases are present at more than one site in the spinal canal in 33% of patients with malignant cord compression
- Surgical fixation requires good bone texture either side of a lesion, so this area must be imaged too
Question 5:
What are the most common malignant causes of cord compression?
- Lung cancer (25%)
- Prostate cancer (16%)
- Myeloma (11%)
- Non-Hodgkin lymphoma (8%)
- Breast cancer (7%)
Question 6:
What cancers have the highest cancer-specific incidence rates?
- Myeloma (15% of myeloma cases)
- Hodgkin lymphoma (8%)
- Non-Hodgkin lymphoma (6%)
- Prostate cancer (5%)