Can decompressive surgery improve outcome in patients with metastatic epidural spinal-cord compression?
Jonathan Knisely* and John Strugar
Correspondence *Yale University School of Medicine, Department of Therapeutic Radiology, 333 Cedar Street, New Haven, CT 06520, USA
Email jonathan.knisely@yale.edu
This article has no abstract so we have provided the first paragraph of the full text.
MESCC is a catastrophic complication of metastatic cancer. The growth of an osseous metastasis to the spine causes pain, and MESCC ultimately results in incontinence, paralysis, and sensory loss below the level of compression. The oncologic management of MESCC from metastatic cancer has relied heavily upon fractionated irradiation to treat the tumor, and corticosteroids to treat edema.1, 2 After irradiation, systemic management appropriate to the underlying malignancy is given. Evaluation of various radiotherapy fractionation schemes and corticosteroid dosing regimens has not, however, demonstrated great differences in patient outcomes. Further, it has been debated whether aggressive surgical intervention is appropriate in a population with a limited life expectancy. Small and retrospective studies have been unable to answer questions about the use of surgery. Therefore, few changes have occurred over the past few decades in what frequently presents as an urgent, if not emergent, issue on a Friday afternoon.
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