Surgical approach to epidural spinal cord compression.
NOMS provides a framework to make decisions regarding surgery or radiation in the face of changing technology. NOMS reflects the most important decision points including neurologic, oncologic, mechanical stability, and systemic disease. Currently, patients who have high-grade epidural spinal cord compression (N) from radioresistant disease (O) or demonstrate mechanical instability (M) are offered surgery if they can tolerate it from a systemic (S) standpoint. Patients with radiosensitive tumors (O) are offered external beam radiation regardless of the degree of spinal cord compression (N). Patients with radioresistant tumors (O) who do not have significant spinal cord compression (N) are now offered IGIMRT as the best chance of controlling local tumor and avoiding an operation.
Bilsky
Mark
M
Division of Surgery, Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA. bilskym@mskcc.org
Smith
Michelle
M
D003937:Diagnosis, Differential; D004824:Epidural Space / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D013117:Spinal Cord Compression / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D013120:Spinal Cord Neoplasms / Q000175:diagnosis / Q000556:secondary / Q000601:surgery; D016896:Treatment Outcome