Metastatic epidural spinal cord compression / Thoracic spine

Figure 2. Epidural spinal cord compression on magnetic resonance imaging (MRI). Sagittal T1-weighted MRI through the thoracic spine demonstrates lymphoma (arrows) involving the T5 and T12 vertebral bodies extending posteriorly into the spinal canal and compressing the spinal cord (c) at both levels. T8 indicates the T8 vertebral body, and A indicates anterior.
Adapted with permission from Quint DJ. Indications for emergent MRI of the central nervous system. JAMA 2000;283:854.


Metastatic epidural spinal cord compression (MESCC) occurs when cancer metatasises to the vertebral bodies of the spine or epidural space and causes secondary compression of the spinal cord. MESCC is a common complication of malignancy that affects almost 5 percent of patients with cancer. Systemic cancers with a tendency for spinal cord metastasis include the following: breast, prostate, renal, or lung neoplasms: lymphoma, sarcoma, and multiple myeloma. Most frequently metastatic seeding appears in the thoracic spine, accounting for about 70 percent of the cases.

MESCC is a medical emergency that needs rapid diagnosis and treatment if permanent paralysis is to be prevented. Appoxiamately 90 percent of patients who are ambulatory at the time of diagnosis do not lose this ability posttreatment. New back pain in patients with cancer suggests epidural spinal cord compression. Pain that worsens when the patient is lying down or with percussion of vertebral bodies is characteristic of the condition. Later neurologic signs like incontinence and loss of sensory function are associated with permanent paraplegia.

The diagnosis of MESCC is best determined with the use of magnetic resonance imaging. MRI has surpassed myelography as the imaging study of choice. Most patients with epidural spinal cord compression need radiation treatment or surgery. Asymptomatic patients should be considered for immediate radiation therapy, and patients with progressive symptoms despite radiation therapy should be considered for sergical intervention.