Maligna utesnitev hrbtenjače Malignant spinal cord compression

a case report with general review

Abstract

Maligna utesnitev hrbtenjače predstavlja eno izmed nujnih stanj v onkologiji. Izrazit je pomen hitrega ukrepanja znotraj 24 ur, ki pripomore k izidu zdravljenja in nadaljnji kvaliteti življenja bolnika. V večini primerov ima bolnik že znano diagnozo raka, vendar se pri nekaterih maligna utesnitev hrbtenjače pojavi kot prva klinična manifestacija. Le-ta je najpogosteje posledica utesnitve hrbtenjače in hrbteničnega kanala bodisi zaradi rasti tumorja neposredno iz vretenca v svetlino kanala redkeje pa je posledica pritiska kostnih odlomkov na hrbtenjačo, intramedularnih ali leptomeningealnih zasevkov. Najpogosteje je prizadeta prsna hrbtenica. V klinični sliki je vodilni simptom navadno bolečina v predelu hrbtenice, v statusu pa je značilen izpad senzoričnih in/ali motoričnih funkcij z nivojem, ki odraža mesto lezije. Skladno z mestom okvare so lahko pridružene sfinkterske motnje. Največji pomen v diagnostiki maligne utesnitve hrbtenjače ima slikanje z magnetno resonanco. Pomemben pristop k zdravljenju predstavlja radioterapija z ali brez predhodnega kirurškega posega. V prispevku je prikazan primer 60-letnega bolnika z rakom prostate z znanimi kostnimi zasevki in maligno utesnitvijo hrbtenjače.

Abstract (Eng)

Malignant spinal cord compression is one of the most serious complications of cancer and represents an oncologic emergency. Timely diagnosis and treatment within 24 hours of symptom onset affects disease outcome and patient’s quality of life. Most of the patients that present with spinal cord compression have a known diagnosis of cancer, yet in some of them spinal cord compression is the first clinical manifestation of the disease. Most cases of spinal cord compression are the result of tumour growth from the vertebral body into the spinal canal, dislocation of bone fragments, intramedullary and leptomeningeal metastases are less frequent causes of spinal cord compression. The most common site of malignant spinal cord compression is the thoracic spine. Back pain is the first symptom in majority of patients, later sensory and/or motor deficits and loss of sphincter control can occur. Magnetic resonance imaging of the whole spine is the gold standard in the diagnostic of malignant spinal cord compression. Radiotherapy with or without surgery is the most common treatment approach. We present a case of a patient with prostate cancer with known bone metastases and spinal cord compression.