Acta Neurochirurgica

, Volume 139, Issue 2, pp 105–111 | Cite as

Radiologic features compared to clinical findings in a prospective study of 153 patients with metastatic spinal cord compression treated by radiotherapy

  • S. Helweg-Larsen
  • A. Johnsen
  • J. Boesen
  • P. S. Sørensen
Clinical Articles


Plain radiography, myelography and post-myelographic CT-scan are described and related to clinical findings in a prospective study of 153 consecutive patients with myelographic signs of spinal cord compression. The majority of the metastatic tumours arise in the vertebral body or the pedicles. In 80% of the patients with total blockage to the contrast medium on myelography the post-myelographic-CT showed passage of the contrast medium. Ambulatory function at time of diagnosis was correlated to the degree and the localization of the epidural block. In 64 patients who underwent a second myelography, the post-treatment findings of sensory function were correlated to radiological regression.


Metastatic spinal cord compression radiological findings 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Arcangeli G, Micheli A, Giannarelli D, La Pasta O, Tollis A, Vitullo A, Ghera S, Benassi M (1989) The responsiveness of bone metastases to radiotherapy: the effect of site, histology and radiation dose on pain relief. Radiother Oncol 14: 95–101PubMedCrossRefGoogle Scholar
  2. 2.
    Arguello F, Baggs RB, Duerst RE, Johnstone L, McQueen K, Frantz CN (1990) Pathogenesis of vertebral metastasis and epidural spinal cord compression. Cancer 65: 98–106PubMedCrossRefGoogle Scholar
  3. 3.
    Barron KD, Hirano A, Araki S, Terry RD (1959) Experiences with metastatic neoplasms involving the spinal cord. Neurology 9: 91–106PubMedGoogle Scholar
  4. 4.
    Batson OV (1940) The function of teh vertebral veins and their role on the spread of metastases. Ann Surg 112: 138–149PubMedCrossRefGoogle Scholar
  5. 5.
    Boland PJ, Lane JM, Sundaresan N (1982) Metastatic disease of the spine. Clin Orthop 169: 95–102PubMedGoogle Scholar
  6. 6.
    Boogerd W, van der Sande JJ, Kroger R (1992) Early diagnosis and treatment of spinal epidural metastasis in breast cancer: a prospective study. J Neurol Neurosurg Psychiatry 55: 1188–1193PubMedGoogle Scholar
  7. 7.
    Byrne TN (1992) Spinal cord compression from epidural metastases. N Engl J Med 327: 614–619PubMedCrossRefGoogle Scholar
  8. 8.
    Constans JP, de Divitiis E, Donzelli R, Spaziante R, Meder JF, Haye C (1983) Spinal metastases with neurological manifestations. Review of 600 cases. J Neurosurg 59: 111–118PubMedCrossRefGoogle Scholar
  9. 9.
    Findlay GF (1987) The role of vertebral body collapse in the management of malignant spinal cord compression. J Neurol Neurosurg Psychiatry 50: 151–154PubMedGoogle Scholar
  10. 10.
    Fornasier VL, Horne JG (1975) Metastases to the vertebral column. Cancer 36: 590–594PubMedCrossRefGoogle Scholar
  11. 11.
    Galasko CS (1982) Mechanisms of lytic and blastic metastatic disease of bone. Clin Orthop 169: 20–27PubMedGoogle Scholar
  12. 12.
    Gilbert RW, Kim JH, Posner JB (1978) Epidural spinal cord compression from metastatic tumor: diagnosis and treatment. Ann Neurol 3: 40–51PubMedCrossRefGoogle Scholar
  13. 13.
    Greenberg HS, Kim JH, Posner JB (1980) Epidural spinal cord compression from metastatic tumor: results with a new treatment protocol. Ann Neurol 8: 361–366PubMedCrossRefGoogle Scholar
  14. 14.
    Helweg-Larsen S, Sørensen PS (1994) Symptoms and signs in metastatic spinal cord compression: a study of progression from first symptom until diagnosis in 153 patients. Eur J Cancer 30A: 396–398PubMedCrossRefGoogle Scholar
  15. 15.
    Kamby C, Vejborg I, Daugaard S, Guldhammer B, Dirksen H, Rossing N, Mouridsen HT (1987) Clinical and radiologic characteristics of bone metastases in breast cancer. Cancer 60: 2524–2531PubMedCrossRefGoogle Scholar
  16. 16.
    Klein J, Keiding H, Kreiner S (1995) Graphical models for panel studies, illustrated on data from the Framingham heart study. Stat Med 14: 1265–1290PubMedCrossRefGoogle Scholar
  17. 17.
    Kreiner S (1987) Analysis of multidimensional contingency tables by exact conditionel tests: techniques and strategies. Scand Journ Stat 14: 97–112Google Scholar
  18. 18.
    Maranzano E, Latini P, Checcaglini F, Perrucci E, Aristei C, Panizza BM, Ricci S (1992) Radiation therapy of spinal cord compression caused by breast cancer: report of a prospective trial. Int J Radiat Oncol Biol Phys 24: 301–306PubMedGoogle Scholar
  19. 19.
    Maranzano E, Latini P, Checcaglini F, Ricci S, Panizza BM, Aristei C, Perrucci E, Beneventi S, Corgna E, Tonato M (1991) Radiation therapy in metastatic spinal cord compression. A prospective analysis of 105 consecutive patients. Cancer 67: 1311–1317PubMedCrossRefGoogle Scholar
  20. 20.
    Modic MT, Masaryk T, Boumphrey F, Goormastic M, Bell G (1986) Lumbar herniated disk disease and canal stenosis: prospective evaluation by surface coil MR, CT, and myelography. AJR Am J Roentgenol 147: 757–765PubMedGoogle Scholar
  21. 21.
    Mones RJ, Dozier D, Berrett A (1996) Analysis of medical treatment of malignant extradural spinal cord tumors. Cancer 19: 1842–1853CrossRefGoogle Scholar
  22. 22.
    Portenoy RK, Lipton RB, Foley KM (1987) Back pain in the cancer patient: an algorithm for evaluation and management. Neurology 37: 134–138PubMedGoogle Scholar
  23. 23.
    Ratanatharathorn V, Powers WE (1991) Epidural spinal cord compression from metastatic tumor: diagnosis and guidelines for management. Cancer Treat Rev 18: 55–71PubMedCrossRefGoogle Scholar
  24. 24.
    Redmond J, Friedl KE, Cornett P, Stone M, O’Rourke T, George CB (1988) Clinical usefulness of an algorithm for the early diagnosis of spinal metastatic disease. J Clin Oncol 6: 154–157PubMedGoogle Scholar
  25. 25.
    Rodichok LD, Harper GR, Ruckdeschel JC, Price A, Roberson G, Barron KD, Horton J (1981) Early diagnosis of spinal epidural metastases. Am J Med 70: 1181–1188PubMedCrossRefGoogle Scholar
  26. 26.
    Rodichok LD, Ruckdeschel JC, Harper GR, Cooper G, Prevosti L, Fernando L, Baxter DH (1986) Early detection and treatment of spinal epidural metastases: the role of myelography. Ann Neurol 20: 696–702PubMedCrossRefGoogle Scholar
  27. 27.
    Rodriguez M, Dinapoli RP (1980) Spinal cord compression: with special reference to metastatic epidural tumors. Mayo Clin Proc 55: 442–448PubMedGoogle Scholar
  28. 28.
    Ruff RL, Lanska DJ (1989) Epidural metastases in prospectively evaluated veterans with cancer and back pain. Cancer 63: 2234–2241PubMedCrossRefGoogle Scholar
  29. 29.
    Schimandle JH, Levine AM (1992) An isolated nonosseous metastasis to the epidural space from an osteogenic sarcoma. Cancer 69: 103–107PubMedCrossRefGoogle Scholar
  30. 30.
    Sundaresan N, Digiacinto GV, Hughes JE, Cafferty M, Vallejo A (1991) Treatment of neoplastic spinal cord compression: results of a prospective study. Neurosurgery 29: 645–650PubMedCrossRefGoogle Scholar
  31. 31.
    Sørensen PS, Borgesen SE, Rohde K, Rasmusson B, Bach F, Boge Rasmussen T, Stjernholm P, Larsen BH, Agerlin N, Gjerris Fet al (1990) Metastatic epidural spinal cord compression. Results of treatment and survival. Cancer 65: 1502–1508PubMedCrossRefGoogle Scholar
  32. 32.
    Tomita T, Galicich JH, Sundaresan N (1983) Radiation therapy for spinal epidural metastases with complete block. Acta Radiol Oncol 22: 135–143PubMedGoogle Scholar
  33. 33.
    Whittaker J (1993) Graphical interaction models: a new approach for statistical modelling. In: Dean K (ed) Population health research. Linking theory and methods. Sage, London, pp 160–180Google Scholar
  34. 34.
    Wong DA, Fornasier VL, MacNab I (1990) Spinal metastases: the obvious, the occult, and the impostors. Spine 15: 1–4PubMedCrossRefGoogle Scholar
  35. 35.
    Zelefsky MJ, Scher HI, Krol G, Portenoy RK, Leibel SA, Fuks ZY (1992) Spinal epidural tumor in patients with prostate cancer. Clinical and radiographic prediction of response to radiation therapy. Cancer 70: 2319–2325PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 1997

Authors and Affiliations

  • S. Helweg-Larsen
    • 2
  • A. Johnsen
    • 1
  • J. Boesen
    • 1
  • P. S. Sørensen
    • 2
  1. 1.Department of NeuroradiologyRigshospitaletCopenhagenDenmark
  2. 2.Department of NeurologyRigshospitaletCopenhagenDenmark

Personalised recommendations