Spinal Cord Compression from Epidural Metastases

EPIDURAL spinal cord compression from metastases is among the most dreaded complications of cancer; it occurs in 5 percent of patients who die of cancer1 2 3 (approximately 20,000 patients a year in the United States). If untreated, metastatic epidural compression inexorably progresses, causing paralysis, sensory loss, and sphincter incontinence. Since the most important single factor determining prognosis is the level of neurologic function at the beginning of therapy,4 5 6 7 the daunting clinical challenge is to diagnose the condition and begin treatment before neurologic injury occurs.Metastases to the spine, which are far more common than primary spinal neoplasms, are classified as epidural, . . .