Abstract
The past few years have witnessed remarkable advances in spinal imaging, radiosurgery, and minimally invasive procedures, such as vertebroplasty and kyphoplasty, as well as improved spinal surgical options with stabilization through instrumentation. These advances provide opportunities to treat patients with vertebral metastases and metastatic epidural spinal cord compression (MESCC) more successfully. In addition, a new study demonstrates that the time to develop motor weakness is an independent prognostic factor in outcome in patients with MESCC. These advances are reviewed.
Similar content being viewed by others
References and Recommended Reading
Lablaw DA, Laperriere N: Emergency treatment of malignant extradural spinal cord compression: an evidence-based guideline. J Clin Oncol 1998, 16:1613–1624.
Schiff D: Spinal cord compression. Neurol Clin North Am 2003, 21:67–86.
Gilbert RW, Kim JH, Posner JB: Epidural spinal cord compression from metastatic tumor: Diagnosis and treatment. Ann Neurol 1978, 3:40–51.
Young RF, Post EM, King GA: Treatment of spinal epidural metastases: Randomized prospective comparison of laminectomy and radiotherapy. J Neurosurg 1980, 53:741–748.
Byrne TN: Spinal cord compression from epidural metastases. N Engl J Med 1992, 327:614–619.
Findlay GF: Adverse effects of the management of malignant spinal cord compression. J Neurol Neurosurg Psychiatry 1984, 47:761–768.
Maranzano E, Latini P: Effectiveness of radiation without surgery in metastatic spinal cord compression: final results from a prospective trial. Int J Radiat Oncol Biol Phys 1995, 32:959–967.
Helweg-Larsen S, Hansen SW, Sorensen PS: Second occurrence of symptomatic metastatic spinal cord compression and findings of multiple spinal epidural metastases. Int J Radiat Oncol Biol Phys 1995, 33:595–598.
Shah AN, Pietroban R, Richardson WJ, Myers BS: Patterns of tumor spread and risk of fracture and epidural impingement in metastatic vertebrae. J Spinal Disord Tech 2003, 16:83–89. An analysis of the pathophysiology of vertebral invasion, fracture, and epidural extension from metastatic cancer.
Gabriel EM, Nashold BS: History of spinal cord stereotaxy. J Neurosurg 1996, 65:725–731.
Helweg-Larsen S, Soresen PS, Kreiner S: Prognostic factors in metastatic spinal cord compression: a prospectve study using multivariate analysis of variables influencing survival and gait function in 153 patients. Int J Radiat Oncol Biol Phys 2000, 46:1163–1169.
Rades D, Heidenreich F, Karstens JH: Final results of a prospective study of the prognostic value of the time to develop motor deficits before irradiation in metastatic spinal cord compression. Int J Radiat Oncol Biol Phys 2002, 53:975–979. This study identifies the prognostic significance of the time to develop motor deficits in the outcome of MESCC. The authors found that those who rapidly lose motor function fare far worse than those who have an indolent deterioration. Furthermore, those with an indolent deterioration also have a greater likelihood of recovering ambulation following treatment.
Byrne TN, Benzel EC, Waxman SG: Diseases of the Spine and Spinal Cord. New York: Oxford University Press; 2000.
Ropper AH, Poskanzer DC: The prognosis of acute and subacute transverse myelopathy based on early signs and symptoms. Ann Neurol 1978, 4:51–59.
Takacs I, Hamilton AJ: Extracranial stereotactic radiosurgery. Neurosurg Clin North Am 1999, 10:257–269.
Ryu S, Yin FF, Rock J, et al.: Image-guided and intensitymodulated radiosurgery for patients with spinal metastasis. Cancer 2003, 97:2013–2018. A feasibility study for the use of radiosurgery for spine metastasis.
Kammerlen P, Thiesse P, Jonas P, et al.: Percutaneous injection of orthopedic cement in metastatic vertebral lesions. N Engl J Med 1989, 321:121.
Fourney DR, Schomer DF, Nader R, et al.: Percutaneous vertebroplasty and kyphoplasty for painful vertebral fractures in cancer patients. J Neurosurg 2003, 98:21–30. A retrospective study reviewing percutaneous vertebroplasty and kyphoplasty.
Cotton A, Dewaire F, Cortet B, et al.: Percutaneous vertebroplasty for osteolytic metastases and myeloma: Effects of the percentage of lesion filling and the leakage of methyl methacrylate at clinical follow-up. Radiology 1996, 200:525–530.
Weill A, Chiras J, Simon J, et al.: Spinal metastases: Indications for and results of percutaneous injection of acrylic surgical cement. Radiology 1996, 199:241–247.
Hodler J, Peck D, Gilula LA: Midterm outcome after vertebroplasty: Predictive value of technical and patient-related factors. Radiology 2003, 227:662–668. A report on the use of vertebroplasty for vertebral metastasis.
Hirabayashi H, Ebara S, Kinoshita T, et al.: Clinical outcome and survival after palliative surgery for spinal metastases. Cancer 2003, 97:476–484. A large series spanning older and modern surgical techniques.
Gerszten PC, Welch WC: Current surgical management of metastatic spinal disease. Oncology 2000, 14:1013–1024.
Klekamp J, Samil H: Surgical results for spinal metastases. Acta Neurochir (Wien) 1998, 140:957–967.
Patchell R, Tibbs PA, Regine WF, et al.: A randomized trial of direct decompressive surgical resection in the treatment of spinal cord compression caused by metastasis [abstract]. J Clin Oncol 2003, 21:237S.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Byrne, T.N. Metastatic epidural cord compression. Curr Neurol Neurosci Rep 4, 191–195 (2004). https://doi.org/10.1007/s11910-004-0038-0
Issue Date:
DOI: https://doi.org/10.1007/s11910-004-0038-0