Surgery Versus Radiation Therapy in Symptomatic Malignant Spinal Cord Compression

Abstract

Malignant epidural spinal cord compression is an oncologic emergency that often results in pain and neurologic dysfunction, which may be permanent. Few prospective studies have been performed to determine whether surgical intervention confers a significant benefit over radiation therapy. We believe the small amount of existing evidence to support surgical intervention or radiation therapy alone suffers from patient selection bias, and that such bias tends to bear out in practice as well. In addition to the objective benefits achieved by surgical decompression, practitioners need to consider the subjective benefits such as increased ambulatory ability, increased spine stability, and improved pain management provided by timely surgical decompression of metastatic spinal cord lesions.