METASTATIC EPIDURAL SPINAL-CORD COMPRESSION - CURRENT CONCEPTS AND TREATMENT

Metastatic epidural spinal cord compression (MESCC) is a medical emerg ency complicating the course of 5-10% of patients with cancer [1]. Whe n diagnosis and treatment is early with the patient ambulatory prognos is for continued ambulation is good [2]. If the patient is nonambulato ry or paraplegic, prognosis for meaningful recovery of motor and bladd er function is markedly decreased. In the last decade, significant adv ances in the understanding, management and treatment of metastatic epi dural spinal cord compression have occurred. Recent pathophysiological and pharmacological animals studies have afforded insights into disea se mechanisms [3-9]. The audit of standard methods of investigation an d magnetic resonance imaging have resulted in revision of guidelines f or patient evaluation [10-17]. Finally, new surgical philosophies and technical advances have generated interest and controversy [18-25]. Wi th improved clinical awareness, new imaging modalities will help us di agnose epidural spinal cord compression earlier and institute appropri ate treatment.