Spinal Cord Compression - Paediatric Palliative Care
Description General and supportive measures Medicine treatment Referral DESCRIPTION Loss of neurological function in limbs (usually lower) caused by spinal compression from tumour or other disease process. Should be managed as an emergency in an attempt to delay complete loss of function for as long as possible. Caused in children by intramedullary or intradural metastases or extradural compressi
General and supportive measures
DESCRIPTION
Loss of neurological function in limbs (usually lower) caused by spinal compression from tumour or other disease process. Should be managed as an emergency in an attempt to delay complete loss of function for as long as possible.
Caused in children by intramedullary or intradural metastases or extradural compression (e.g. vertebral collapse).
Early signs:
- Change in nature of long-standing pain.
- Neuropathic pain radiating down legs.
- Positive Lhermitte’s sign: electric shock-like pain on neck flexion.
Late signs:
- Limb weakness, sensory deficits – level detected, decreased to absent reflexes, paraplegia.
GENERAL AND SUPPORTIVE MEASURES
- Early detection in high-risk patients.
- Once established manage as per paraplegia with careful attention to pressure support as well as bowel and bladder care (intermittent catheterisation).
MEDICINE TREATMENT
Commence high dose dexamethasone:
- Dexamethasone, IV:
- Loading dose of 1–2 mg/kg followed by 0.25–0.5 mg/kg every 6 hours has been suggested.
REFERRAL
- Palliative radiotherapy.
Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter: 21. Palliative Care, 21.2 Paediatric Palliative Care Emergencies, 21.2.2 Spinal Cord Compression