Treatment of metastatic spinal epidural disease

a review of the literature.

Paul Klimo, John R. Kestle, Meic H. Schmidt

Research output: Contribution to journalReview article

48 Citations (Scopus)

Abstract

OBJECT: Spinal cord compression is one of the most dreaded complications of metastatic cancer. It can lead to a number of sequelae, including pain, spinal instability, neurological deficits, and a reduction in the patient's quality of life. Except in selected circumstances, treatment is palliative. Treatment options include surgery, radiation, and chemotherapy. The goal of this study was to summarize the existing data on the outcomes of various treatment methods for metastatic spinal epidural disease and to make appropriate recommendations for their use. METHODS: The authors used a search strategy that included an electronic database search, a manual search of journals, analysis of bibliographies in relevant review papers, and consultation with the senior author. There is good evidence, including Class I data, that steroid drugs constitute a beneficial adjunctive therapy in patients with myelopathy from epidural compression. Historically, conventional radiation therapy has been viewed as the first-line treatment because it has been shown to be as effective as a decompressive laminectomy, with a lower incidence of complications (Class II data). Nevertheless, in the last 20 years there has been remarkable progress in surgical techniques and technology. Currently, the goals of surgery are to achieve a circumferential decompression of the spinal cord, and to reconstruct and immediately stabilize the spinal column. Results in a large body of literature support the belief that surgery is better at retaining or regaining neurological function than radiation and that surgery is highly effective in relieving pain. Most of the data on the treatment of metastatic spinal disease are Class II or III, but the preliminary results of a well-designed, randomized controlled trial in which surgery is compared with standard radiation therapy represents the first Class I data. CONCLUSIONS: As the number of treatment options for metastatic spinal disease has grown, it has become clear that effective implementation of these treatments can only be achieved by a multidisciplinary approach.

Original languageEnglish (US)
JournalNeurosurgical Focus
Volume15
Issue number5
StatePublished - Jan 1 2003
Externally publishedYes

Fingerprint

Spinal Diseases
Radiotherapy
Therapeutics
Radiation
Pain
Spinal Cord Compression
Laminectomy
Spinal Cord Diseases
Bibliography
Decompression
Palliative Care
Spinal Cord
Spine
Referral and Consultation
Randomized Controlled Trials
Steroids
Quality of Life
Databases
Technology
Drug Therapy

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Treatment of metastatic spinal epidural disease : a review of the literature. / Klimo, Paul; Kestle, John R.; Schmidt, Meic H.

In: Neurosurgical Focus, Vol. 15, No. 5, 01.01.2003.

Research output: Contribution to journalReview article

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