Spinal cord compression medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Dexamethasone (a potent glucocorticoid) in doses of 16 mg/day may reduce edema around the lesion and protect the cord from injury. It may be given orally or intravenously for this indication.

Medical treatment

All the patients with acute spinal cord compression must be admitted. The mainstay of treatment includes surgery for most of the cases except for compression caused by metastasis. The treatment in such cases is mostly palliative. Antibiotics are indicated in cases of compression caused by an epidural abscess.

Antibiotics

• Preferred regimen (1): vancomycin 15-20 mg/kg IV q8-12h and metronidazole 500 mg IV q6h and cefotaxime 2 g IV q6h

Maintaince of fluid volume

• Goal is to mainatain systotic bp above 100 mmhg and an adequate urine output (0.5 mL/kg/hour) using volume resuscitation, and vasopressors.
• Preffered regimen: volume resuscitation using fluid replacement with isotonic crystalloid solution to a maximum of 2 L is the initial treatment of choice.
• Alternative regimen : Dopamine 1-50 micrograms/kg/minute IV q8h.

Corticosteroids

• Preferred regimen: Methylprednisone 30 mg/kg intravenously as a bolus given over 15 minutes followed by 5.4 mg/kg/hour intravenous infusion for 24 hours (if <3 hours since injury) or for 48 hours (if 3-8 hours since injury)

Prophylaxis for venous thromboembolism

• Preferred regimen: Enoxaparin 40 mg subcutaneously q24h
• Alternative regimen (1): Heparin 5000 units subcutaneously q8-12h
• Alternative regimen (2): IVC filter (in patients with contraindications to anticoagulation)

Prevention of stress ulcers

• Preferred regimen (1): Omeprazole 40 mg orally q24h
• Preferred regimen (2): Cimetidine 300 mg orally/intravenously q6h
• Preferred regimen (3): Famotidine 40 mg orally q24h (or) 20 mg intravenously q12h

Supportive therapies

• Nutritional support
• Compression stockings or pneumatic intermittent compression
• Bladder catheterization
• Frequent repositioning of the patient for the prevention of pressure ulcers every 2 hours