title: ACR Appropriateness Criteria® Metastatic Epidural Spinal Cord Compression and Recurrent Spinal Metastasis.
abstract: Metastatic epidural spinal cord compression (MESCC) is an oncologic emergency and if left untreated, permanent paralysis will ensue. The treatment of MESCC is governed by disease, patient, and treatment factors. Patient's preferences and goals of care are to be weighed into the treatment plan. Ideally, a patient with MESCC is evaluated by an interdisciplinary team promptly to determine the urgency of the clinical scenario. Treatment recommendations must take into consideration the risk-benefit profiles of surgical intervention and radiotherapy for the particular individual's circumstance, including neurologic status, performance status, extent of epidural disease, stability of the spine, extra-spinal disease status, and life expectancy. In patients with high spinal instability neoplastic score (SINS) or retropulsion of bone fragments in the spinal canal, surgical intervention should be strongly considered. The rate of development of motor deficits from spinal cord compression may be a prognostic factor for ultimate functional outcome, and should be taken into account when a treatment recommendation is made. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
authors.affiliation: 1 University Hospitals Seidman Cancer Center, Case Western Reserve University , Cleveland, Ohio.
authors.forename: Simon Shek-Man
authors.initials: SS
authors.lastname: Lo
authors.affiliation: 2 Stony Brook University School of Medicine , Stony Brook, New York.
authors.forename: Samuel
authors.initials: S
authors.lastname: Ryu
authors.affiliation: 3 University of Southern California-Keck School of Medicine , Los Angeles, California.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Chang
authors.affiliation: 4 University Hospitals of Cleveland , Cleveland, Ohio.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Galanopoulos
authors.affiliation: 5 University of Pennsylvania Perelman Center , Philadelphia, Pennsylvania.
authors.forename: Joshua
authors.initials: J
authors.lastname: Jones
authors.affiliation: 6 University of Washington , Seattle, Washington.
authors.forename: Edward Y
authors.initials: EY
authors.lastname: Kim
authors.affiliation: 7 Oregon Health & Science University , Portland, Oregon.
authors.forename: Charlotte D
authors.initials: CD
authors.lastname: Kubicky
authors.affiliation: 8 Texas Oncology, Flower Mound and Carrollton, Texas.
authors.forename: Charles P
authors.initials: CP
authors.lastname: Lee
authors.affiliation: 9 Mayo Clinic , American Academy of Orthopaedic Surgeons, Rochester, Minnesota.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Rose
authors.affiliation: 10 Sunnybrook Health Sciences Centre , Toronto, Ontario, Canada .
authors.forename: Arjun
authors.initials: A
authors.lastname: Sahgal
authors.affiliation: 11 University Hospitals , Case Medical Center, Cleveland, Ohio.
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Sloan
authors.affiliation: 12 The Methodist Hospital , Houston, Texas.
authors.forename: Bin S
authors.initials: BS
authors.lastname: Teh
authors.affiliation: 13 University Hospitals Seidman Cancer Center, Case Western Reserve University , Cleveland, Ohio.
authors.forename: Bryan J
authors.initials: BJ
authors.lastname: Traughber
authors.affiliation: 14 University of Michigan Comprehensive Cancer Center , American Society of Clinical Oncology, Ann Arbor, Michigan.
authors.forename: Catherine
authors.initials: C
authors.lastname: Van Poznak
authors.affiliation: 15 Cleveland Clinic , Strongsville, Ohio.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Vassil
mesh_terms: D000368:Aged; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012008:Recurrence; D012955:Societies, Medical; D013117:Spinal Cord Compression / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D013125:Spinal Neoplasms / Q000150:complications / Q000556:secondary*; D019452:Terminally Ill