Spinal cord compression. With special reference to metastatic epidural tumors

Compression of the spinal cord or cauda equina is an increasingly important problem in cancer patients. The most common primary tumors are carcinoma of the breast in women and carcinoma of the lung in men. Metastases invade the epidural space by extension from involved vertebrae, by growth through intervertebral foramina, and by hematogenous dissemination. Pain is the usual initial symptom, followed by progressive sensory, motor, and sphincteric dysfunction. Appropriate x-ray films of the spine are positive in most patients, and complete myelographic examination to delineate the exact location and extent of the compression is essential. Patients generally require emergency management; results of treatment depend primarily on the neurologic status at the time of diagnosis. Corticosteroids should be administered in an effort to reduce compressive edema. Decompressive laminectomy followed by radiation therapy is indicated for patients with compression of unknown cause, relapse during or after radiation therapy, or certain radioresistant tumors. Primary radiation therapy is indicated for patients with lymphoma and some patients with carcinoma.