Sign Up for a Free Account
  • Updated 02.07.2022
  • Released 12.29.1993
  • Expires For CME 02.07.2025

Metastatic epidural spinal cord compression

Introduction

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 one 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 from a metastatic lesion outside the spinal dura. In one 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 (25). "Pain in the back" was noted to precede the appearance of cord dysfunction. The cord symptoms were often noted to progress rapidly to flaccid paraplegia, although a slowly progressive spastic paraplegia could occur.

This is an article preview.
Start a Free Account
to access the full version.

  • Nearly 3,000 illustrations, including video clips of neurologic disorders.

  • Every article is reviewed by our esteemed Editorial Board for accuracy and currency.

  • Full spectrum of neurology in 1,200 comprehensive articles.

Questions or Comment?

MedLink®, LLC

3525 Del Mar Heights Rd, Ste 304
San Diego, CA 92130-2122

Toll Free (U.S. + Canada): 800-452-2400

US Number: +1-619-640-4660

Support: service@medlink.com

Editor: editor@medlink.com

ISSN: 2831-9125