Neoplastik Spinal Kord Kompresyonları
Özet
Neoplastik spinal kord kompresyonları (NSKB), vertebra metastazı olan hastaların yaklaşık %10'unda gelişen ve hızlı müdahale gerektiren onkolojik bir acil durumdur. En sık akciğer, prostat ve meme kanserlerine bağlı olarak torasik bölgede meydana gelen bu patoloji, tümörün vertebral kemikten epidural mesafeye doğrudan uzanması veya patolojik kırıklar sonucu spinal kordun sıkışmasıyla oluşur. Hastalarda en yaygın klinik bulgu sırt ağrısı olup, zamanla ilerleyici motor güçsüzlük, duyusal kayıplar ile mesane ve bağırsak disfonksiyonu eşlik eder. Tanıda altın standart, tüm spinal hat değerlendirmesine olanak tanıyan kontrastlı ve kontrastsız manyetik rezonans (MR) görüntülemedir. Tedavi yaklaşımı multidisipliner olup; vertebral ödemi ve nörolojik defisit ilerlemesini azaltmak amacıyla yüksek doz deksametazon tedavisine köprü olarak başlanır. Definitif tedavi planlamasında, cerrahi ve radyoterapi kararları tümörün radyosensitivitesi, spinal instabilite varlığı ve hastanın sistemik durumunu değerlendiren NOMS algoritmasına göre belirlenir. Radyorezistan tümörlerde, omurga instabilitesinde veya yüksek dereceli kompresyonlarda cerrahi dekompresyon ve stabilizasyon ön plana çıkarken; radyosensitif tümörlerde ve cerrahiyi tolere edemeyen palyatif hastalarda radyoterapi tercih edilen temel tedavi yöntemidir.
Neoplastic spinal cord compression (NSCC) is an oncological emergency that develops in approximately 10% of patients with vertebral metastases and requires prompt intervention. Most commonly occurring in the thoracic region due to lung, prostate, and breast cancers, this pathology results from the direct extension of the tumor from the vertebral bone into the epidural space or pathological fractures compressing the spinal cord. The most frequent clinical presentation is back pain, which is progressively accompanied by motor weakness, sensory deficits, and bladder or bowel dysfunction. The gold standard for diagnosis is contrast and non-contrast total spinal magnetic resonance imaging (MRI), allowing for a comprehensive evaluation of the spinal column. Management is multidisciplinary, routinely initiating high-dose dexamethasone therapy as a bridge to definitive treatment to minimize vertebral edema and neurological deterioration. Definitive treatment planning depends on the NOMS framework, which evaluates tumor radiosensitivity, spinal instability, and the patient's systemic status to guide surgical and radiotherapy decisions. While surgical decompression and stabilization are preferred in radioresistant tumors, spinal instability, or high-grade compressions, radiotherapy remains the primary modality for radiosensitive tumors or palliative patients unable to tolerate surgery.
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