Download PDF
Semin Neurol 2010; 30(3): 245-253
DOI: 10.1055/s-0030-1255221
© Thieme Medical Publishers

Metastatic Epidural Spinal Cord Compression

Jennie W. Taylor1 , David Schiff1
  • 1Department of Neurology, University of Virginia Health System, Charlottesville, Virginia
Further Information

Publication History

Publication Date:
24 June 2010 (online)

    Permissions and Reprints

ABSTRACT

Metastatic epidural spinal cord compression is a debilitating consequence of multiple cancer types. Early diagnosis and treatment are imperative for improving functional outcome. The authors review the epidemiology, pathophysiology, clinical features, and diagnostic evaluation of metastatic epidural spinal cord compression. Special attention will be given to the supportive and definitive treatments available for management, and new therapeutic interventions, such as radiosurgery, will be briefly discussed as well.

KEYWORDS

Spinal metastasis - epidural spinal cord compression - radiosurgery

REFERENCES

  • 1 Loblaw D A, Laperriere N J, Mackillop W J. A population-based study of malignant spinal cord compression in Ontario.  Clin Oncol (R Coll Radiol). 2003;  15 211-217
    CrossrefPubMedGoogle Scholar
  • 2 Bach F, Larsen B H, Rohde K et al.. Metastatic spinal cord compression. Occurrence, symptoms, clinical presentations and prognosis in 398 patients with spinal cord compression.  Acta Neurochir (Wien). 1990;  107(1-2) 37-43
    CrossrefPubMedGoogle Scholar
  • 3 Barron K D, Hirano A, Araki S, Terry R D. Experiences with metastatic neoplasms involving the spinal cord.  Neurology. 1959;  9(2) 91-106
    CrossrefPubMedGoogle Scholar
  • 4 Schaberg J, Gainor B J. A profile of metastatic carcinoma of the spine.  Spine (Phila Pa 1976). 1985;  10(1) 19-20
    CrossrefPubMedGoogle Scholar
  • 5 Loblaw D A, Laperriere N J. Emergency treatment of malignant extradural spinal cord compression: an evidence-based guideline.  J Clin Oncol. 1998;  16(4) 1613-1624
    PubMedGoogle Scholar
  • 6 Schiff D, O'Neill B P, Wang C H, O'Fallon J R. Neuroimaging and treatment implications of patients with multiple epidural spinal metastases.  Cancer. 1998;  83(8) 1593-1601
    CrossrefPubMedGoogle Scholar
  • 7 Helweg-Larsen S, Sørensen P S, Kreiner S. Prognostic factors in metastatic spinal cord compression: a prospective study using multivariate analysis of variables influencing survival and gait function in 153 patients.  Int J Radiat Oncol Biol Phys. 2000;  46(5) 1163-1169
    CrossrefPubMedGoogle Scholar
  • 8 Sørensen S, Børgesen S E, Rohde K et al.. Metastatic epidural spinal cord compression. Results of treatment and survival.  Cancer. 1990;  65(7) 1502-1508
    CrossrefPubMedGoogle Scholar
  • 9 Schiff D, O'Neill B P, Suman V J. Spinal epidural metastasis as the initial manifestation of malignancy: clinical features and diagnostic approach.  Neurology. 1997;  49(2) 452-456
    CrossrefPubMedGoogle Scholar
  • 10 Hirabayashi H, Ebara S, Kinoshita T et al.. Clinical outcome and survival after palliative surgery for spinal metastases: palliative surgery in spinal metastases.  Cancer. 2003;  97(2) 476-484
    CrossrefPubMedGoogle Scholar
  • 11 Maranzano E, Latini P. Effectiveness of radiation therapy without surgery in metastatic spinal cord compression: final results from a prospective trial.  Int J Radiat Oncol Biol Phys. 1995;  32(4) 959-967
    CrossrefPubMedGoogle Scholar
  • 12 Constans J P, de Divitiis E, Donzelli R, Spaziante R, Meder J F, Haye C. Spinal metastases with neurological manifestations. Review of 600 cases.  J Neurosurg. 1983;  59(1) 111-118
    CrossrefPubMedGoogle Scholar
  • 13 Gilbert R W, Kim J H, Posner J B. Epidural spinal cord compression from metastatic tumor: diagnosis and treatment.  Ann Neurol. 1978;  3(1) 40-51
    CrossrefPubMedGoogle Scholar
  • 14 Kim R Y, Spencer S A, Meredith R F et al.. Extradural spinal cord compression: analysis of factors determining functional prognosis—prospective study.  Radiology. 1990;  176(1) 279-282
    PubMedGoogle Scholar
  • 15 Sundaresan N, Rothman A, Manhart K, Kelliher K. Surgery for solitary metastases of the spine: rationale and results of treatment.  Spine (Phila Pa 1976). 2002;  27 1802-1806
    CrossrefPubMedGoogle Scholar
  • 16 Henson R, Urich H. Cancer and the Nervous System. Oxford; Blackwell Scientific Publications 1982
    PubMedGoogle Scholar
  • 17 Perrin R G, Livingston K E, Aarabi B. Intradural extramedullary spinal metastasis. A report of 10 cases.  J Neurosurg. 1982;  56(6) 835-837
    CrossrefPubMedGoogle Scholar
  • 18 Batson O V. The function of the vertebral veins and their role in spread of metastases.  Ann Surg. 1940;  112(1) 138-149
    CrossrefPubMedGoogle Scholar
  • 19 Coman D R, deLONG R P. The role of the vertebral venous system in the metastasis of cancer to the spinal column; experiments with tumor-cell suspensions in rats and rabbits.  Cancer. 1951;  4(3) 610-618
    CrossrefPubMedGoogle Scholar
  • 20 Arguello F, Baggs R B, Duerst R E, Johnstone L, McQueen K, Frantz C N. Pathogenesis of vertebral metastasis and epidural spinal cord compression.  Cancer. 1990;  65(1) 98-106
    CrossrefPubMedGoogle Scholar
  • 21 Khaw F M, Worthy S A, Gibson M J, Gholkar A. The appearance on MRI of vertebrae in acute compression of the spinal cord due to metastases.  J Bone Joint Surg Br. 1999;  81(5) 830-834
    CrossrefPubMedGoogle Scholar
  • 22 Ikeda H, Ushio Y, Hayakawa T, Mogami H. Edema and circulatory disturbance in the spinal cord compressed by epidural neoplasms in rabbits.  J Neurosurg. 1980;  52(2) 203-209
    CrossrefPubMedGoogle Scholar
  • 23 Kato A, Ushio Y, Hayakawa T, Yamada K, Ikeda H, Mogami H. Circulatory disturbance of the spinal cord with epidural neoplasm in rats.  J Neurosurg. 1985;  63(2) 260-265
    CrossrefPubMedGoogle Scholar
  • 24 Siegal T, Siegal T. Spinal metastases. In: Schiff D, O' Neill BP Principles of Neuro-Oncology. New York, NY; McGraw-Hill 2005: 581-606
    PubMedGoogle Scholar
  • 25 Ushio Y, Posner R, Kim J H, Shapiro W R, Posner J B. Treatment of experimental spinal cord compression caused by extradural neoplasms.  J Neurosurg. 1977;  47(3) 380-390
    CrossrefPubMedGoogle Scholar
  • 26 Sørensen S, Helweg-Larsen S, Mouridsen H, Hansen H H. Effect of high-dose dexamethasone in carcinomatous metastatic spinal cord compression treated with radiotherapy: a randomised trial.  Eur J Cancer. 1994;  30A(1) 22-27
    PubMedGoogle Scholar
  • 27 Asdourian P L, Weidenbaum M, DeWald R L, Hammerberg K W, Ramsey R G. The pattern of vertebral involvement in metastatic vertebral breast cancer.  Clin Orthop Relat Res. 1990;  250(250) 164-170
    PubMedGoogle Scholar
  • 28 Cowap J, Hardy J R, A'Hern R. Outcome of malignant spinal cord compression at a cancer center: implications for palliative care services.  J Pain Symptom Manage. 2000;  19(4) 257-264
    CrossrefPubMedGoogle Scholar
  • 29 Posner J B. Spinal metastases. In: Posner JB Neurologic Complications of Cancer. Philadelphia, PA; FA Davis 1995: 111-142
    PubMedGoogle Scholar
  • 30 Sciubba D M, Gokaslan Z L. Diagnosis and management of metastatic spine disease.  Surg Oncol. 2006;  15(3) 141-151
    CrossrefPubMedGoogle Scholar
  • 31 Gabriel K, Schiff D. Metastatic spinal cord compression by solid tumors.  Semin Neurol. 2004;  24(4) 375-383
    Article in Thieme ConnectPubMedGoogle Scholar
  • 32 Helweg-Larsen S, Sørensen P S. Symptoms and signs in metastatic spinal cord compression: a study of progression from first symptom until diagnosis in 153 patients.  Eur J Cancer. 1994;  30A(3) 396-398
    PubMedGoogle Scholar
  • 33 Greenberg H S, Kim J H, Posner J B. Epidural spinal cord compression from metastatic tumor: results with a new treatment protocol.  Ann Neurol. 1980;  8(4) 361-366
    CrossrefPubMedGoogle Scholar
  • 34 Carmody R F, Yang P J, Seeley G W, Seeger J F, Unger E C, Johnson J E. Spinal cord compression due to metastatic disease: diagnosis with MR imaging versus myelography.  Radiology. 1989;  173(1) 225-229
    PubMedGoogle Scholar
  • 35 Algra P R, Bloem J L, Tissing H, Falke T H, Arndt J W, Verboom L J. Detection of vertebral metastases: comparison between MR imaging and bone scintigraphy.  Radiographics. 1991;  11(2) 219-232
    PubMedGoogle Scholar
  • 36 Francken A B, Hong A M, Fulham M J, Millward M J, McCarthy W H, Thompson J F. Detection of unsuspected spinal cord compression in melanoma patients by 18F-fluorodeoxyglucose-positron emission tomography.  Eur J Surg Oncol. 2005;  31(2) 197-204
    CrossrefPubMedGoogle Scholar
  • 37 Rosenthal D I. Radiologic diagnosis of bone metastases.  Cancer. 1997;  80(8, Suppl) 1595-1607
    CrossrefPubMedGoogle Scholar
  • 38 Byrne T N. Spinal cord compression from epidural metastases.  N Engl J Med. 1992;  327(9) 614-619
    CrossrefPubMedGoogle Scholar
  • 39 Colletti P M, Dang H T, Deseran M W, Kerr R M, Boswell W D, Ralls P W. Spinal MR imaging in suspected metastases: correlation with skeletal scintigraphy.  Magn Reson Imaging. 1991;  9(3) 349-355
    CrossrefPubMedGoogle Scholar
  • 40 Mut M, Schiff D, Shaffrey M E. Metastasis to nervous system: spinal epidural and intramedullary metastases.  J Neurooncol. 2005;  75(1) 43-56
    CrossrefPubMedGoogle Scholar
  • 41 Kattapuram S V, Khurana J S, Rosenthal D I. Percutaneous needle biopsy of the spine.  Spine (Phila Pa 1976). 1992;  17(5) 561-564
    CrossrefPubMedGoogle Scholar
  • 42 Stoker D J, Kissin C M. Percutaneous vertebral biopsy: a review of 135 cases.  Clin Radiol. 1985;  36(6) 569-577
    CrossrefPubMedGoogle Scholar
  • 43 Babu N V, Titus V T, Chittaranjan S, Abraham G, Prem H, Korula R J. Computed tomographically guided biopsy of the spine.  Spine (Phila Pa 1976). 1994;  19(21) 2436-2442
    CrossrefPubMedGoogle Scholar
  • 44 Martenson Jr J A, Evans R G, Lie M R et al.. Treatment outcome and complications in patients treated for malignant epidural spinal cord compression (SCC).  J Neurooncol. 1985;  3(1) 77-84
    PubMedGoogle Scholar
  • 45 Weissman D E. Glucocorticoid treatment for brain metastases and epidural spinal cord compression: a review.  J Clin Oncol. 1988;  6(3) 543-551
    PubMedGoogle Scholar
  • 46 Weiner H L, Rezai A R, Cooper P R. Sigmoid diverticular perforation in neurosurgical patients receiving high-dose corticosteroids.  Neurosurgery. 1993;  33(1) 40-43
    CrossrefPubMedGoogle Scholar
  • 47 Sundaresan N, Sachdev V P, Holland J F et al.. Surgical treatment of spinal cord compression from epidural metastasis.  J Clin Oncol. 1995;  13(9) 2330-2335
    PubMedGoogle Scholar
  • 48 Perrin R G. Metastatic tumors of the axial spine.  Curr Opin Oncol. 1992;  4(3) 525-532
    CrossrefPubMedGoogle Scholar
  • 49 Dworkin R H, Backonja M, Rowbotham M C et al.. Advances in neuropathic pain: diagnosis, mechanisms, and treatment recommendations.  Arch Neurol. 2003;  60(11) 1524-1534
    CrossrefPubMedGoogle Scholar
  • 50 Ross J R, Saunders Y, Edmonds P M, Patel S, Broadley K E, Johnston S RD. Systematic review of role of bisphosphonates on skeletal morbidity in metastatic cancer.  BMJ. 2003;  327(7413) 469
    CrossrefPubMedGoogle Scholar
  • 51 Schiff D. Treatment and prognosis of neoplastic epidural spinal cord compression, including cauda equina syndrome. Uptodate.com 2009 Available at: http://www.utdol.com/online/content/topic.do?topicKey=genl_onc Accessed November 13, 2009
    PubMedGoogle Scholar
  • 52 Zaidat O O, Ruff R L. Treatment of spinal epidural metastasis improves patient survival and functional state.  Neurology. 2002;  58(9) 1360-1366
    CrossrefPubMedGoogle Scholar
  • 53 Ruff R L, Lanska D J. Epidural metastases in prospectively evaluated veterans with cancer and back pain.  Cancer. 1989;  63(11) 2234-2241
    CrossrefPubMedGoogle Scholar
  • 54 Findlay G F. Adverse effects of the management of malignant spinal cord compression.  J Neurol Neurosurg Psychiatry. 1984;  47(8) 761-768
    CrossrefPubMedGoogle Scholar
  • 55 Young R F, Post E M, King G A. Treatment of spinal epidural metastases. Randomized prospective comparison of laminectomy and radiotherapy.  J Neurosurg. 1980;  53(6) 741-748
    CrossrefPubMedGoogle Scholar
  • 56 Klimo Jr P, Thompson C J, Kestle J RW, Schmidt M H. A meta-analysis of surgery versus conventional radiotherapy for the treatment of metastatic spinal epidural disease.  Neuro-oncol. 2005;  7(1) 64-76
    CrossrefPubMedGoogle Scholar
  • 57 Sze W M, Shelley M, Held I, Wilt T J, Mason M D. Palliation of metastatic bone pain: Single fraction versus multifraction radiotherapy – a systematic review of randomized trials.  Cochrane Database Syst Rev. 2004;  (2) CD0004721
    PubMedGoogle Scholar
  • 58 Sze W M, Shelley M, Held I, Mason M. Palliation of metastatic bone pain: single fraction versus multifraction radiotherapy – a systematic review of randomized trials.  Cochrane Database Syst Rev. 2004;  (2) CD0004721
    PubMedGoogle Scholar
  • 59 Maranzano E, Trippa F, Casale M et al.. 8Gy single-dose radiotherapy is effective in metastatic spinal cord compression: results of a phase III randomized multicentre Italian trial.  Radiother Oncol. 2009;  93(2) 174-179
    CrossrefPubMedGoogle Scholar
  • 60 Rades D, Rudat V, Veninga T et al.. A score predicting posttreatment ambulatory status in patients irradiated for metastatic spinal cord compression.  Int J Radiat Oncol Biol Phys. 2008;  72(3) 905-908
    CrossrefPubMedGoogle Scholar
  • 61 Rades D, Hoskin P J, Karstens J H et al.. Radiotherapy of metastatic spinal cord compression in very elderly patients.  Int J Radiat Oncol Biol Phys. 2007;  67(1) 256-263
    CrossrefPubMedGoogle Scholar
  • 62 Yamada Y, Lovelock D M, Bilsky M H. A review of image-guided intensity-modulated radiotherapy for spinal tumors.  Neurosurgery. 2007;  61(2) 226-235 discussion 235
    CrossrefPubMedGoogle Scholar
  • 63 Loblaw D A, Perry J, Chambers A, Laperriere N J. Systematic review of the diagnosis and management of malignant extradural spinal cord compression: the Cancer Care Ontario Practice Guidelines Initiative's Neuro-Oncology Disease Site Group.  J Clin Oncol. 2005;  23(9) 2028-2037
    CrossrefPubMedGoogle Scholar
  • 64 Rades D, Heidenreich F, Karstens J H. 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(4) 975-979
    CrossrefPubMedGoogle Scholar
  • 65 Helweg-Larsen S, Rasmusson B, Sørensen P S. Recovery of gait after radiotherapy in paralytic patients with metastatic epidural spinal cord compression.  Neurology. 1990;  40(8) 1234-1236
    PubMedGoogle Scholar
  • 66 Gerszten P C, Burton S A, Ozhasoglu C, Welch W C. Radiosurgery for spinal metastases: clinical experience in 500 cases from a single institution.  Spine (Phila Pa 1976). 2007;  32(2) 193-199
    CrossrefPubMedGoogle Scholar
  • 67 Yamada Y, Bilsky M H, Lovelock D M et al.. High-dose, single-fraction image-guided intensity-modulated radiotherapy for metastatic spinal lesions.  Int J Radiat Oncol Biol Phys. 2008;  71(2) 484-490
    CrossrefPubMedGoogle Scholar
  • 68 Gibbs I C, Patil C, Gerszten P C, Adler Jr J R, Burton S A. Delayed radiation-induced myelopathy after spinal radiosurgery.  Neurosurgery. 2009;  64(2, Suppl) A67-A72
    CrossrefPubMedGoogle Scholar
  • 69 Portenoy R K, Galer B S, Salamon O et al.. Identification of epidural neoplasm. Radiography and bone scintigraphy in the symptomatic and asymptomatic spine.  Cancer. 1989;  64(11) 2207-2213
    CrossrefPubMedGoogle Scholar
  • 70 Kostuik J P, Errico J N. Differential diagnosis and surgical treatment of metastatic spine tumors. In: Frymoyer JW The Adult Spine. New York, NY; Raven Press 1991: 861-888
    PubMedGoogle Scholar
  • 71 Tomita K, Kawahara N, Kobayashi T, Yoshida A, Murakami H, Akamaru T. Surgical strategy for spinal metastases.  Spine (Phila Pa 1976). 2001;  26(3) 298-306
    CrossrefPubMedGoogle Scholar
  • 72 McLain R F, Weinstein J N. Tumors of the spine.  Semin Spine Surg. 1990;  2 157-180
    PubMedGoogle Scholar
  • 73 Ghogawala Z, Mansfield F L, Borges L F. Spinal radiation before surgical decompression adversely affects outcomes of surgery for symptomatic metastatic spinal cord compression.  Spine (Phila Pa 1976). 2001;  26(7) 818-824
    CrossrefPubMedGoogle Scholar
  • 74 Patchell R A, Tibbs P A, Regine W F et al.. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial.  Lancet. 2005;  366(9486) 643-648
    CrossrefPubMedGoogle Scholar
  • 75 Tokuhashi Y, Matsuzaki H, Oda H, Oshima M, Ryu J. A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis.  Spine (Phila Pa 1976). 2005;  30(19) 2186-2191
    CrossrefPubMedGoogle Scholar
  • 76 Chi J H, Gokaslan Z, McCormick P, Tibbs P A, Kryscio R J, Patchell R A. Selecting treatment for patients with malignant epidural spinal cord compression-does age matter?: results from a randomized clinical trial.  Spine (Phila Pa 1976). 2009;  34(5) 431-435
    CrossrefPubMedGoogle Scholar
  • 77 Chaichana K L, Woodworth G F, Sciubba D M et al.. Predictors of ambulatory function after decompressive surgery for metastatic epidural spinal cord compression.  Neurosurgery. 2008;  62(3) 683-692 discussion 683-692
    CrossrefPubMedGoogle Scholar
  • 78 Bilsky M H, Lis E, Raizer J, Lee H, Boland P. The diagnosis and treatment of metastatic spinal tumor.  Oncologist. 1999;  4(6) 459-469
    PubMedGoogle Scholar

David SchiffM.D. 

Department of Neurology, University of Virginia Health System, Box 800432, Charlottesville

VA 22908-0432

Email: DS4JD@hscmail.mcc.virginia.edu