[Paradigm shift in the management of metastatic epidural spinal cord compression: the importance of preserving ambulation].
In 2005, a Landmark study showed that direct decompressive surgery, followed by postoperative external beam radiotherapy (EBRT) is superior to EBRT alone in patients with metastatic epidural spinal cord compression (MESCC). Patients undergoing both surgery and EBRT had similar median survival but experienced longer ambulation than with EBRT alone. Additional studies have shown improvements in quality-of-life, higher cost-effectiveness, improved pain control, and higher functional status with surgery plus EBRT. Improved neurological outcome also improved the patients' ability to undergo postoperative adjuvant therapy. According to our experience, even patients over 65 or patients with aggressive primary tumors and additional metastases have benefited from surgical intervention, living longer than expected with preservation of ambulation and sphincter control until death or shortly before. Preserving ambulation is critical. With current surgical devices and techniques, patients with MESCC who present with a single area of cord compression, back pain, neurological deficit, or progressive deformity, may benefit from surgery prior to adjuvant radiation-based treatment or chemotherapy.
Department of Neurosurgery, Hadassah-Hebrew University Hospital. eyal.itshayek@gmail.com
Eyal
E
Itshayek
D000367:Age Factors; D000368:Aged; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D019299:Decompression, Surgical / Q000379:methods*; D015174:Epidural Neoplasms / Q000556:secondary / Q000628:therapy*; D006801:Humans; D011788:Quality of Life; D013117:Spinal Cord Compression / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D013120:Spinal Cord Neoplasms / Q000556:secondary / Q000628:therapy*; D015996:Survival Rate; D016896:Treatment Outcome; D016138:Walking