Metastatic epidural spinal cord compression

John T Fortunato MD (

Dr. Fortunato of the University of Chicago has no relevant financial relationships to disclose.

)
Deric M Park MD (

Dr. Park of the University of Chicago has no relevant financial relationships to disclose.

)
Rimas V Lukas MD, editor. (

Dr. Lukas of Northwestern University Feinberg School of Medicine received honorariums from AbbVie and Novocure for speaking engagements, from Eisai for consulting work, and from Monetris as an advisory board member.

)
Originally released December 29, 1993; last updated March 31, 2020; expires March 31, 2023

This article includes discussion of metastatic epidural spinal cord compression and metastatic extradural spinal cord compression. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

This article 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. In this update, the authors add information on manuscripts covering the epidemiology, prognosis, and treatment of metastatic spinal cord compression with surgery and stereotactic radiotherapy. Newer treatment modalities including laser interstitial thermal therapy and cryoablation are also discussed.

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.

 

• Inability to walk at presentation is a poor prognostic sign.

 

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, laser interstitial thermal therapy, or chemotherapy.

Historical note and terminology

Metastatic epidural spinal cord compression is defined as compression of the spinal cord or nerve roots in the cauda equina from a metastatic lesion outside the spinal dura. In 1 of the earliest reviews on extradural spinal cord tumors, this entity was classified as primary extradural (arising from structures within the vertebral canal), secondary extradural (arising from structures outside the vertebral canal that secondarily invade the extradural space), and metastatic (Elsberg 1928). "Pain in the back" was noted to precede the appearance of cord dysfunction. The cord symptoms were often noted to progress rapidly to a flaccid paraplegia, although a slowly progressive spastic paraplegia could occur. In a review of neurologic complications of cancer from a cancer hospital, the most frequent diagnosis was spinal cord compression (18%).

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