Journal of Neuro-Oncology

, Volume 3, Issue 1, pp 77–84 | Cite as

Treatment outcome and complications in patients treated for malignant epidural spinal cord compression (SCC)

  • James A MartensonJr
  • Richard G Evans
  • Margart R Lie
  • Duane M Ilstrup
  • Robert P Dinapoli
  • Michael J Ebersold
  • John D Earle


Sixty-seven episodes of spinal cord compression (SCC) were retrospectively evaluated regarding presenting features and treatment outcome. They were divided into three motor function groups. Group 1 consisted of 35 ambulatory patients, group 2 of 29 non-ambulatory patients and group 3 of three paraplegic patients. Lower extremity weakness was usually a late presenting feature and was frequently rapidly progressive. We suggest that SCC is an emergency, as successful treatment is unlikely if motor function is poor. All of the group 1 patients completing treatment remained ambulatory, in contrast to group 2 patients, in which only 25% regained the ability to walk, and group 3 patients, none of whom regained the ability to walk. Initial surgery or initial radiotherapy appeared to be equally effective in restoring or maintaining the ability to walk. Survival of patients ambulatory at completion of treatment was superior to that of non-ambulatory patients (p < 0.03). Analysis of steroid-related complications suggested that frequent, severe and sometimes fatal complications can result from prolonged use with these drugs.


spinal cord compression radiation therapy decompressive laminectomy 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Gilbert RW, Kim JH, Posner JB: Epidural spinal cord compression from metastatic tumor: Diagnosis and treatment. Ann Neurol 3:40–51, 1978.Google Scholar
  2. 2.
    Barron K, Hirano A, Shukuro A, Terry R: Experiences with metastatic neoplasms involving the spinal cord. Neurology (Minneap)9:91–106, 1959.Google Scholar
  3. 3.
    Rodriguez M, Dinapoli RP: Spinal cord compression with special reference to metastatic epidural tumors. Mayo Clin Proc 55:442–448,1980.Google Scholar
  4. 4.
    Posner J: Management of central nervous system metastases. Semin Onco1 4(1):81–91, 1977.Google Scholar
  5. 5.
    Marshall LF, Langfitt TW: Combined therapy for metastatic extradural tumors of the spine. Cancer 40:2067–2070, 1977.Google Scholar
  6. 6.
    Posner J: Spinal cord compression: A neurological emergency. Clin Bull 1:65–71, 1971.Google Scholar
  7. 7.
    Tang SG, Byfield JE, Sharp TR, Utley JF, Quinol L, Seagren S: Prognostic factors in the management of metastatic epidural spinal cord compression. J Neuro Oncology 1(1):21–28,1983.Google Scholar
  8. 8.
    Young RF, Post EM, King GA: Treatment of spinal epidural metastases. Randomized prospective comparison of laminectomy and radiotherapy. J Neurosurg 53:741–748, 1980.Google Scholar
  9. 9.
    Greenburg HS, Kim JH, Posner JB: Epidural spinal cord compression from metastatic tumor: Results with a new treatment protocol. Ann Neurol 8:361–366, 1980.Google Scholar
  10. 10.
    Ch'ien LT, Kalwinsky DK, Peterson G, Pratt CB, Murphy SB, Hayes FA, Green AA, Hustu HO: Metastatic epidural tumors in children. Medical Pediat Oncology 10:455–462, 1982.Google Scholar
  11. 11.
    Livingston KE, Perrin RG: The neurosurgical management of spinal metastases causing cord and cauda equina compression. J Neurosurg 49:839–843, 1978.Google Scholar
  12. 12.
    Benson H, Scarffe J, Todd ID, Palmer M, Crowther D: Spinal cord compression in myeloma. Br Med J 1:1541–1544, 1979.Google Scholar
  13. 13.
    Amin P, Salazar O: Prognostic factors in treatment of metastatic spinal cord compression (Abstract). Int J Radiat Oncol Biol Phys 9 (supplement):90, 1983.Google Scholar
  14. 14.
    Bastron J, Bickford R, Brown J, Clark E, Corbin K, Goldstein N, Howard F, Lambert E, Lass D, Millikan C, Mulder C, Rooke E, Rushton J, Siekert R, Thomas J, Whisnant J: In: Section of Neurology and Section of Physiology, Mayo Clinic and Mayo Foundation: Clinical Examinations in Neurology, 2nd edn. W B Saunders Company, Philadelphia, 1963, jacket insert.Google Scholar
  15. 15.
    Aronson A, Bastron J, Brown J, Burton R, Corbin K, Darley F, Engel A, Goldstein N, Gomez M, Groover R, Howard F, Klass D, Lambert E, Millikan C, Mulder C, Rooke E, Rushton J, Sandok B, Siekert R, Thomas J, Waltz A, Whisnant J: In: Section of Neurology and Section of Physiology, Mayo Clinic and Mayo Foundation: Clinical Examinations in Neurology, 3rd edn. WB Saunders Company. Philadelphia, 1971, pp 100–126 and 178–19 I.Google Scholar
  16. 16.
    Kaplan EL, Meier P: Non-parametric estimation from incomplete observations. J Am Stat Assoc 53:457–481, 1958.Google Scholar
  17. 17.
    Peto R, Peto J: Asymptomatically efficient rank invariant procedures (with discussion). J Roy Stat Soc Series A, 135:185–207, 1972.Google Scholar
  18. 18.
    Bansal S, Brady L, Olsen A, Faust D, Osterholm J, Kazmen I: The treatment of metastatic spinal cord tumors. JAMA 202(8):686–688,1967.Google Scholar
  19. 19.
    Brice J, McKissock W: Surgical treatment of malignant extradural spinal tumours. Br Med J 2:1341–1344, 1965.Google Scholar
  20. 20.
    Vieth R, Olson G: Extradural spinal metastases and their neurosurgical management. J Neurosurg 23:501–508, 1965.Google Scholar
  21. 21.
    Dunn RC, Kelly WA, Wohns RNW, Howe JF: Spinal epidural neoplasia. A 15-year review of the results of surgical therapy. J Neurosurg 52:47–51, 1980.Google Scholar
  22. 22.
    Wright RL: Malignant tumors in the spinal extradural space: Results of surgical treatment. Ann Surg 157(2):227–231, 1963.Google Scholar
  23. 23.
    White WA, Patterson RH, Bergland RM: Role of surgery in the treatment of spinal cord compression by metastatic neoplasm. Cancer 27:558–561, 1971.Google Scholar
  24. 24.
    Alexander E, Courtland D, Field C: Metastatic lesions of the vertebral column causing cord compression. Neurology (Minneap) 6:103, 1956.Google Scholar
  25. 25.
    Collins W, Duncan C, Wagner F, Spencer D, Prioleau G: Neurological surgery. In: Schwartz S, Shires G, Spencer F, Storer E, (eds) Principles of Surgery, 4th edn. McGraw-Hill Book Company, New York, 1983, pp 1781–1828.Google Scholar
  26. 26.
    Kramer R: Spinal tumors. In: Sabiston D, (ed) Davis-Christopher Textbook of Surgery. The Biological Basis of Modern Surgical Practice, 12th edn. WB Saunders Company, Philadelphia, 1981, pp 1492–1494.Google Scholar
  27. 27.
    Khan FR, Glicksman AS, Chu FCH, Nickson JJ: Treatment by radiotherapy of spinal cord compression due to extradural metastases. Radiology 89:495–500, 1967.Google Scholar
  28. 28.
    Raichle M, Posner J: The treatment of extradural spinal cord compression (Abstract). Neurology 20 (supplement): 391, 1970.Google Scholar
  29. 29.
    Bruckman JE, Bloomer WD: Management of spinal cord compression. Semin Oncol 5(2):135–140, 1978.Google Scholar
  30. 30.
    Gilbert H, Apuzzo M, Marshall L, Kagan A, Crue B, Wagner J, Fuchs K, Rush J, Rao A, Naassbaum H, Chan P: Neoplastic epidural spinal cord compression. A current perspective. JAMA 240(5): 2771–2773, 1978.Google Scholar
  31. 31.
    Ushio Y, Posner R, Posner J, Shapiro W: Experimental spinal cord compression by epidural neoplasms. Neurology (Minneap) 27:422–429, 1977.Google Scholar
  32. 32.
    Ushio Y, Posner R, Kim J, Shapiro W, Posner J: Treatment of experimental spinal cord compression caused by extradural neoplasms. J Neurosurg 47:380–390, 1977.Google Scholar
  33. 33.
    Posner J, Howieson J, Esteban C: ‘Disappearing’ spinal cord compresion: Oncolytic effect of glucocorticoids (and other chemotherapeutic agents) on epidural metastases. Ann Neurol 2(5):409–413, 1977.Google Scholar
  34. 34.
    Clarke P, Saunders M: Steroid-induced remission in spinal canal reticulum cell sarcoma. Report of two cases. J Neurosurg 42:346–348, 1975.Google Scholar
  35. 35.
    Canta RC: Corticosteroids for spinal metastases. Lancet 2:912, 1968.Google Scholar

Copyright information

© Martinus Nijhoff Publishers 1985

Authors and Affiliations

  • James A MartensonJr
    • 1
  • Richard G Evans
    • 1
  • Margart R Lie
    • 2
  • Duane M Ilstrup
    • 3
  • Robert P Dinapoli
    • 4
  • Michael J Ebersold
    • 5
  • John D Earle
    • 1
  1. 1.Division of Therapeutic RadiologyMayo Clinic of Mayo FoundationRochesterUSA
  2. 2.Department of Physical Medicine and RehabilitationMayo Clinic of Mayo FoundationRochesterUSA
  3. 3.Section of Medical Research StatisticsMayo Clinic of Mayo FoundationRochesterUSA
  4. 4.Departments of NeurologyMayo Clinic of Mayo FoundationRochesterUSA
  5. 5.Neurologic SurgeryMayo Clinic of Mayo FoundationRochesterUSA

Personalised recommendations