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Surgery Insight: current management of epidural spinal cord compression from metastatic spine disease

Nature Clinical Practice Neurology volume 2, pages 87–94 (2006)Cite this article

Abstract

Metastatic epidural spinal cord compression (MESCC) is becoming a more common clinically encountered entity as advancing systemic antineoplastic treatment modalities improve survival in cancer patients. Although treatment of MESCC remains a palliative endeavor, emerging surgical techniques, in combination with imaging modalities that detect spinal metastatic disease at an early stage, are resulting in improved outcomes. Here, we review the clinical presentation, diagnostic work-up and management options in the management of MESCC. A treatment paradigm is outlined with emphasis on early circumferential surgical decompression of the spinal cord with concomitant spinal stabilization. Radiation therapy has a clearly defined role in the treatment of patients with MESCC, particularly those with radiation-sensitive tumors in the setting of non-bony spinal cord compression and those with a limited life expectancy. Spinal stereotactic radiosurgery, vertebroplasty, and kyphoplasty, are emerging treatment options that are beginning to be used in selected patients with MESCC.

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Figure 1: Imaging spinal metastatic disease with MRI.
Figure 2: Preoperative embolization.
Figure 3: Artist's illustration of an anterior approach to the upper thoracic spine with combined anterolateral cervical and transsternal access.
Figure 4: Spine stabilization using an expandable titanium cage.
Figure 5: Postoperative (A) anteroposterior and (B) lateral radiographs demonstrating cage placement with combined pedicle screw stabilization.

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Author information

Authors and Affiliations

  1. instructors in neurosurgery, at Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Timothy F Witham & Yevgeniy A Khavkin

  2. neurosurgery resident, at Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Gary L Gallia

  3. assistant professor of neurosurgery, at Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Jean-Paul Wolinsky

  4. The Donlin M Long Professor, Professor of Neurosurgery, Oncology and Orthopedic Surgery, Director of the Neurosurgery Spine Program and Vice-Chairman of the Department of Neurosurgery, at Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Ziya L Gokaslan

Authors
  1. Timothy F Witham
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  2. Yevgeniy A Khavkin
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  3. Gary L Gallia
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  4. Jean-Paul Wolinsky
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  5. Ziya L Gokaslan
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Corresponding author

Correspondence to Ziya L Gokaslan.

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Competing interests

Ziya Gokaslan is a medical advisory member and stock holder for Spinal Kinetics and US Spine. He is a board member for, and has received a stipend and fellowship support from, AO North America. He has also received research study support from Synthes Spine.

Supplementary information

Supplementary Table 1

Results of treatment for spinal cord compression: radiation alone (PDF 11 kb)

Supplementary Table 2

Results of treatment for spinal cord compression: laminectomy with or without radiotherapy (PDF 12 kb)

Supplementary Table 3

Results of treatment for spinal cord compression: laminectomy (posterior decompression) and stabilization (PDF 10 kb)

Supplementary Table 4

Results of treatment for spinal cord compression: vertebral body resection and stabilization (PDF 10 kb)

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Witham, T., Khavkin, Y., Gallia, G. et al. Surgery Insight: current management of epidural spinal cord compression from metastatic spine disease. Nat Rev Neurol 2, 87–94 (2006). https://doi.org/10.1038/ncpneuro0116

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  • DOI: https://doi.org/10.1038/ncpneuro0116

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