Occurs in 3–5% of pts with cancer; tumor may be the initial manifestation of malignancy. Most neoplasms are epidural in origin and result from metastases to the adjacent spinal bones. Almost any malignant tumor can metastasize to the spinal column with lung, breast, prostate, kidney, lymphoma, and plasma cell dyscrasia being particularly frequent.
The thoracic cord is most commonly involved; exceptions include prostate and ovarian tumors, which preferentially involve the lumbar and sacral segments from spread through veins in the anterior epidural space. The most common presenting symptom is localized back pain and tenderness followed by symptoms of neurologic compromise. Urgent MRI is indicated when the diagnosis is suspected; up to 40% of pts with neoplastic cord compression at one level are found to have asymptomatic epidural disease elsewhere, so the entire spine should be imaged. Plain radiographs will miss 15–20% of metastatic vertebral lesions.
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