Current Treatment Options in Neurology

, Volume 14, Issue 4, pp 391–401

Spinal Cord Compression

  • Eduardo Santamaria Carvalhal Ribas
  • David Schiff
NEURO-ONCOLOGY (NEUROPLASMS) (M ROSENFELD, SECTION EDITOR)

DOI: 10.1007/s11940-012-0176-7

Cite this article as:
Ribas, E.S.C. & Schiff, D. Curr Treat Options Neurol (2012) 14: 391. doi:10.1007/s11940-012-0176-7

Opinion statement

Malignant epidural spinal cord compression (MESCC) remains a common neuro-oncologic emergency with high associated morbidity. Despite widespread availability of MRI, the diagnosis frequently goes unmade until myelopathy supervenes, which is unfortunate because the strongest predictor of neurologic outcome with treatment is the neurologic status when treatment is initiated. Once the diagnosis of MESCC is suspected, patients with neurologic deficits should be started on high-dose corticosteroids (eg, dexamethasone, 10–100 mg intravenously, followed by 16 to 100 mg/d in divided doses). Definitive therapy of MESCC almost always includes radiation therapy and in some cases surgical intervention; factors considered include the patient’s performance status and extent of visceral and skeletal disease, spinal stability, the tumor’s underlying radiosensitivity, and the degree of spinal cord compression. Patients with spinal instability or radioresistant tumors are likely to have a much better neurologic outcome with tumor resection and spinal stabilization prior to radiation; the same may also pertain to patients with moderately radiosensitive tumors who have good life expectancy in terms of their systemic tumor. Conventional radiation has historically been beneficial after surgery and in patients who are not surgical candidates. Recent studies suggest a role for stereotactic body radiation therapy in patients with spinal metastasis from radioresistant tumors and in patients who have received prior standard radiotherapy, so long as the spinal cord has been decompressed.

Keywords

Epidural spinal cord compression Radiosurgery Radiation therapy Neoplasm Spinal cord Treatment Stereotactic body radiation therapy Corticosteroids Fractionated radiotherapy Percutaneous radiofrequency ablation Embolization Vertebroplasty Kyphoplasty 

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Eduardo Santamaria Carvalhal Ribas
    • 1
  • David Schiff
    • 1
  1. 1.University of Virginia Neuro-Oncology CenterCharlottesvilleUSA

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