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CNS Oncol. 2017 Jul 18. doi: 10.2217/cns-2016-0044. [Epub ahead of print]

Modern approaches to the management of metastatic epidural spinal cord compression.

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Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT 06510, USA.
Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, ON M4N 3M5, Canada.
Department of Radiation Oncology, Norris Cancer Center & Keck School of Medicine at University of Southern California, Los Angeles, CA 90033, USA.
Department of Medical imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, ON M4N 3M5, Canada.
Department of Radiation Medicine, Oregon Health Science Center, Portland, OR 97239, USA.
Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD 21287, USA.
Department of Orthopaedic Surgery, University of British Columbia, Vancouver, BC V1Y 1T3, Canada.
Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
Department of Radiation Oncology, University of Washington, Seattle, WA 98195, USA.


Metastatic epidural spinal cord compression (MESCC) is an oncologic emergency requiring prompt treatment to maximize neurologic function, ambulatory function and local control. Traditionally, options for MESCC included external beam radiation therapy with or without surgery. Surgery has usually been reserved for the patient with optimal performance status, single level MESCC or mechanical instability. Advances in external beam radiation therapy such as the development of stereotactic body radiation therapy have allowed for the delivery of high-dose radiation, allowing for both long-term pain and local control. Surgical advances, such as separation surgery, minimal access spine surgery and percutaneous instrumentation, have decreased surgical morbidity. This review summarizes the latest advances and evidence in MESCC to enable modern management.


MESCC; SBRT; SRS; metastatic epidural spinal cord compression; stereotactic body radiation therapy; stereotactic radiosurgery

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