Epidural spinal cord compression: Treatment options

Abstract

Abstract The appropriate management of patients with metastatic disease to the spine demands a comprehensive evaluation and decision-making process on the part of the orthopedic surgeon. Each patient must be considered separately, taking into consideration all possible factors, especially the individual's medical status and longevity. While the classification systems presented are far from encompassing, they may serve as treatment guidelines. As the medical treatment of cancer improves, more patients are surviving longer, and, therefore, developing an increasing number of metastatic complications. Surgical intervention should be reserved for those cases in which nonoperative measures have little chance of succeeding or already have failed. When warranted, decompressive procedures are best accomplished by first assessing the location of compression. The indiscrimate use of laminectomy in the past has lead to poor results reported in earlier surgical series. Anterior vertebral body resections with stabilization techniques have led to improved satisfactory outcome. An aggressive approach to these patients remains justifiable in those individuals with an expected longevity of more than 3 to 6 months in order to assure an improved quality of remaining time.