Recurrent spinal epidural metastases: a prospective study with a complete follow up

Objectives-Prospective studies with a complete follow up in patients with s pinal epidural metastases (SEM) are rare, so little is known of the inciden ce and relevance of recurrent spinal epidural metastases (RSEM). This prosp ective study was undertaken as a part of a previously started and extended prospective study to determine the occurrence and details of RSEM. Methods Patients with SEM of various primary malignancies were followed up until death. The diagnosis was confirmed after neurological examination by imaging studies visualising not only the clinically suspected level, but al so as much of the spinal canal as possible. Results-Recurrent spinal epidural metastases (RSEM) occurred in 21 of the 1 03 patients (20%) after a median interval of 7 months and, after treatment, a second recurrence occurred in Ii patients (11%), a third recurrence in t wo patients (2%), and a sixth recurrence in one patient (1%). RSEM develope d about as often at the initial level (55%) as at a different level (45%), did not occur more often in patients with initially multiple SEM, but, not surprisingly, occurred much more often in patients with longer survival. Ab out one half of the patients surviving 2 years, and nearly all patients sur viving 3 years or longer developed RSEM. Ambulatory state could be preserve d in most patients, even after their second recurrence. Conclusion-RSEM are common and even several episodes of RSEM in the same pa tient are not rare. Patients with SEM who survive long enough have a high r isk of RSEM and prompt treatment of RSEM to maintain the ambulatory state o f the patient is valuable.