Metastatic epidural spinal cord compression

Introduction
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By David Schiff MD and Kathryn Nevel MD

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

This clinical summary reviews the epidemiology, diagnosis, prognosis, 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. In this update, Dr. Schiff and Dr. Nevel add information on recent manuscripts covering the epidemiology, prognosis, and treatment of metastatic spinal cord compression with surgery and stereotactic radiotherapy.

Key points

  • Metastatic epidural spinal cord compression must be considered in the differential diagnosis of new back pain in cancer patients.
  • Pain is the most common symptom in metastatic epidural spinal cord compression.
  • Other symptoms can include 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.
  • Systemic steroids should be given immediately to almost all patients with epidural spinal cord compression. Definitive treatment is variable depending on the characteristics of the individual patient but may include 1 or more of the following: surgery, external beam radiation therapy, stereotactic radiotherapy or radiosurgery, or chemotherapy.

In This Article

Introduction
Historical note and nomenclature
Clinical manifestations
Clinical vignette
Etiology
Pathogenesis and pathophysiology
Epidemiology
Prevention
Differential diagnosis
Diagnostic workup
Prognosis and complications
Management
References cited
Contributors