The surgical management of metastatic epidural compression of the spinal cord

• Published in: Journal of bone and joint surgery. British volume Vol. 92; no. 8; pp. 1054 - 1060
• Main Authors: QURAISHI, N. A, GOKASLAN, Z. L, BORIANI, S
• Format: Journal Article
• Language: English
• Published: London British Editorial Society of Bone and Joint Surgery 01.08.2010
• Subjects: Algorithms; Biological and medical sciences; Combined Modality Therapy; Decompression, Surgical - methods; Diseases of the osteoarticular system; Glucocorticoids - therapeutic use; Humans; Medical sciences; Palliative Care - methods; Radiosurgery - methods; Spinal Cord Compression - etiology; Spinal Cord Compression - surgery; Spinal Neoplasms - complications; Spinal Neoplasms - secondary; Spinal Neoplasms - therapy; Extradural; Compression; Spinal cord; Treatment; Surgery; Orthopedics; Malignant tumor; Metastasis; Cancer
• ISSN: 0301-620X; 2044-5377
• DOI: 10.1302/0301-620x.92b8.22296

Metastatic epidural compression of the spinal cord is a significant source of morbidity in patients with systemic cancer. With improved oncological treatment, survival in these patients is improving and metastatic cord compression is encountered increasingly often. The treatment is mostly palliative. Surgical management involves early circumferential decompression of the cord with concomitant stabilisation of the spine. Patients with radiosensitive tumours without cord compression benefit from radiotherapy. Spinal stereotactic radiosurgery and minimally invasive techniques, such as vertebroplasty and kyphoplasty, with or without radiofrequency ablation, are promising options for treatment and are beginning to be used in selected patients with spinal metastases. In this paper we review the surgical management of patients with metastatic epidural spinal cord compression.