Metastatic epidural spinal cord compression

Introduction
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By Harry S Greenberg MD

Metastatic epidural spinal cord compression is also known as or subsumes Metastatic extradural spinal cord compression. -ed.

In this clinical article, Dr. Harry Greenberg of the University of Michigan and Wayne State University reviews the diagnosis and treatment of metastatic epidural spinal cord compression, a neurologic emergency because of the inevitable natural history of lower extremity paralysis and bowel and bladder dysfunction. A randomized study of lesion-directed surgery plus radiation versus radiation alone is cited. Dr. Greenberg includes information on recent articles for the treatment of metastatic spinal cord compression with stereotactic radiosurgery

Key points

  • Cancer patients with new back pain are at risk for metastatic epidural spinal cord compression.
  • Pain is the presenting symptom in metastatic epidural spinal cord compression in greater than 90% of cases, and pain alone can be the only symptom.
  • Other symptoms are motor weakness, sensory loss, and bowel and bladder incontinence. These symptoms often occur late, and outcome is worse when they are present.
  • MRI is the diagnostic procedure of choice.