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
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).
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.
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
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
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%)
What cancers have the highest cancer-specific incidence rates?
- Myeloma (15% of myeloma cases)
- Hodgkin lymphoma (8%)
- Non-Hodgkin lymphoma (6%)
- Prostate cancer (5%)