TN 7 (08-12)
DI 23022.900 Spinal Nerve Root Cancer – metastatic or recurrent
COMPASSIONATE ALLOWANCE INFORMATION
SPINAL NERVE ROOT CANCER
Tumor- Spinal cord; Spinal Root Neoplasm; Spinal Cord Tumor
Spinal Nerve Root Cancer is the growth of cancerous cells arising from the nerve roots rather than the spinal cord (part of the CNS) and usually occurs in the lumbar spine. Spinal Nerve Root Cancer that is metastatic or recurrent occurs when the malignant cancer cells have spread from the nerve roots to other parts of the body, and has come back after treatment. Symptoms of spinal nerve root cancer are related to compression of the nerve tissue or ceramic structures and may include non-mechanical back pain in the middle or lower back, loss of sensation or muscle weakness, difficulty walking, loss of bowel or bladder function, erectile dysfunction, varying degrees of paralysis, and scoliosis of other spinal deformity.
DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM CODING
Diagnostic testing: Diagnostic testing used to confirm the diagnosis of spinal nerve root cancer includes MRI of lumbar spine, CT scan or CT myelogram of the lumbar spine, cerebrospinal fluid (CSF) examination, myelogram, and spine x-ray. A biopsy is used to help determine the grade of the cancer. A neurological examination may help to identify the location of the tumor.
Physical findings: A physical examination may show evidence of abnormal reflexes, increased muscle tone, loss of pain and temperature sensation, muscle weakness, and tenderness in the spine.
ONSET AND PROGRESSION
The outcome of spinal nerve root cancer varies depending on the location, size, and extent (including metastases) of the cancer. Early diagnosis and treatment usually leads to a better outcome. Nerve damage often continues after surgery often leading to neurologic dysfunction. Although some amount of permanent dysfunction is likely, treatment may delay death.
The goal of treatment is to reduce or prevent nerve damage from pressure (compression of) on the spinal cord. Corticosteroids are prescribed to reduce inflammation and swelling around the spinal cord. Surgery is used to remove as much of the tumor as possible and to relieve pressure on the spinal cord. Radiation including radiosurgery (SRS) therapy is used with, or instead, of surgery. Chemotherapy may be used in some cases, but it has not been proven effective against most spinal tumors.
SUGGESTED PROGRAMMATIC ASSESSMENT*
Suggested MER for evaluation: A pathology report if available. If a pathology report is unavailable, a report or radiological studies such as MRI and CT scans may provide the required information.
Suggested Listings for Evaluation:
Requires documented metastases or recurrence
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* Adjudicators may, at their discretion, use the Medical Evidence of Record or Listings suggested to evaluate the claim. However, the decision to allow or deny the claim rests with the adjudicator.