Metastatic Spinal Cord Compression

  • John W. CrommettEmail author
Reference work entry


Metastatic spinal cord compression is a medical emergency characterized by its potential for rapid deterioration of neurological function, often leading to significant impairments in quality of life. The most common mechanism is growth of a vertebral metastatic lesion with invasion of the epidural space and compression of the spinal cord. Patients commonly present with progressive pain and may later develop motor and sensory weakness, and autonomic dysfunction. The preferred imaging study is an MRI of the entire spine, which should be performed urgently. In patients without known malignancy, tissue diagnosis through biopsy as well as evaluation for primary site of disease and other metastases is necessary. Initial management includes steroids and analgesics. Treatment options include radiation and surgical decompression, and considerations include tissue type, an assessment of spinal stability, and performance status. Patients with metastatic spinal cord compression should be managed at centers capable of providing specialized treatment including radiation oncology and neurosurgery.


Metastatic spinal cord compression Vertebral metastasis Intramedullary Corticosteroids Dexamethasone Magnetic resonance imaging Surgical decompression Stereotactic radiation Cancer Radiotherapy Tetraplegia Paraplegia 


  1. 1.
    Algra P, Heimans J, Valk J, Nauta J, Lachniet M, Van Kooten B. Do metastases in vertebrae begin in the body or pedicles? Imaging study in 45 patients. Am J Roentgenol. 1992;158(6):1275–9.CrossRefGoogle Scholar
  2. 2.
    Arguello F, Duerst R, McQueen K, Frantz C, Baggs R, Johnstone L. Pathogenesis of vertebral metastases and epidural spinal cord compression. Cancer. 1990;65: 98–106.PubMedCrossRefGoogle Scholar
  3. 3.
    Bach F, Larsen B, Rhode K, Borgesen S, Gjerris F, Boge-Rasmussen T, Agerlin N, Rasmusson B, Stjernholm P, Sorensen P. Metastatic spinal cord compression. Occurrence, symptoms, clinical presentations and prognosis in 398 patients with spinal cord compression. Acta Neurochir. 1990;107(1–2):37–43.PubMedCrossRefGoogle Scholar
  4. 4.
    Batson O. The function of the vertebral veins and their role in the spread of metastases. Ann Surg. 1940;112(1):138–49.PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Cole J, Patchell R. Metastatic epidural spinal cord compression. Lancet Neurol. 2008;7(5):459–66.PubMedCrossRefGoogle Scholar
  6. 6.
    Coman D, Delong R. The role of the vertebral venous system in the metastasis of cancer to the spinal column. Experiments with tumor-cell suspensions in rats and rabbits. Cancer. 1951;4(3):610–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Constans J, de Divitiis E, Donzelli R, Spaziante R, Meder J, Haye C. Spinal metastases with neurological manifestations. J Neurosurg. 1983;59(1):111–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Desforges J, Byrne T. Spinal cord compression from epidural metastases. N Engl J Med. 1992;327(9): 614–9.CrossRefGoogle Scholar
  9. 9.
    Elsberg C. Diseases of the spinal cord and membranes. Philadelphia: Saunders; 1916. p. 236–42.Google Scholar
  10. 10.
    George R, Jeba J, Ramkumar G, Chacko A, Tharyan P. Interventions for the treatment of metastatic extradural spinal cord compression in adults. Cochrane Database Syst Rev. 2015;4:1–30.Google Scholar
  11. 11.
    Gilbert R, Kim J, Posner J. Epidural spinal cord compression from metastatic tumor: diagnosis and treatment. Ann Neurol. 1978;3(1):40–51.PubMedCrossRefGoogle Scholar
  12. 12.
    Graus F, Krol G, Foley K. Early diagnosis of spinal epidural metastases (SEM): correlation with clinical and radiographic findings. Proc Am Soc Clin Oncol. 1985;4(1):269.Google Scholar
  13. 13.
    Helweg-Larsen S, Sørensen P. Symptoms and signs in metastatic spinal cord compression: a study of progression from first symptom until diagnosis in 153 patients. Eur J Cancer. 1994;30(3):396–8.CrossRefGoogle Scholar
  14. 14.
    Husband D. Malignant spinal cord compression: prospective study of delays in referral and treatment. BMJ. 1998;317(7150):18–21.PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    Husband D, Grant K, Romaniuk C. MRI in the diagnosis and treatment of suspected malignant spinal cord compression. Br J Radiol. 2001;74(877):15–23.PubMedCrossRefGoogle Scholar
  16. 16.
    Jacobs W, Perrin R. Evaluation and treatment of spinal metastases: an overview. Neurosurg Focus. 2001;11(6):1–11.CrossRefGoogle Scholar
  17. 17.
    Jennelle R, Vijayakumar V, Vijayakumar S. A systematic and evidence-based approach to the management of vertebral metastasis. ISRN Surg. 2011;2011:1–6.CrossRefGoogle Scholar
  18. 18.
    Kato A, Ushio Y, Hayakawa T, Yamada K, Ikeda H, Mogami H. Circulatory disturbance of the spinal cord with epidural neoplasm in rats. J Neurosurg. 1985;63(2):260–5.PubMedCrossRefGoogle Scholar
  19. 19.
    Kienstra G, Terwee C, Dekker F, Canta L, Borstlap A, Tijssen C, Bosch D, Tijssen J. Prediction of spinal epidural metastases. Arch Neurol. 2000;57(5):690.PubMedCrossRefGoogle Scholar
  20. 20.
    Klimo P, Thompson C, Kestle J, Schmidt M. A meta-analysis of surgery versus conventional radiotherapy for the treatment of metastatic spinal epidural disease. Neuro-Oncology. 2005;7(1):64–76.PubMedPubMedCentralCrossRefGoogle Scholar
  21. 21.
    Li K, Poon P. Sensitivity and specificity of MRI in detecting malignant spinal cord compression and in distinguishing malignant from benign compression fractures of vertebrae. Magn Reson Imaging. 1988;6(5):547–56.PubMedCrossRefGoogle Scholar
  22. 22.
    Lin A, Avila E. Neurologic emergencies in the patients with Cancer. J Intensive Care Med. 2016;32(2): 99–115.PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Lo S, Ryu S, Chang E, Galanopoulos N, Jones J, Kim E, Kubicky C, Lee C, Rose P, Sahgal A, Sloan A, Teh B, Traughber B, Van Poznak C, Vassil A. ACR appropriateness criteria® metastatic epidural spinal cord compression and recurrent spinal metastasis. J Palliat Med. 2015;18(7):573–84.PubMedCrossRefGoogle Scholar
  24. 24.
    Loblaw D. A population-based study of malignant spinal cord compression in Ontario. Clin Oncol. 2003;15(4):211–7.CrossRefGoogle Scholar
  25. 25.
    Maranzano E, Latini P, Checcaglini F, Ricci S, Panizza B, Aristei C, Perrucci E, Beneventi S, Corgna E, Tonato M. Radiation therapy in metastatic spinal cord compression. A prospective analysis of 105 consecutive patients. Cancer. 1991;67(5):1311–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Olcott E, Dillon W. Plain film clues to the diagnosis of spinal epidural neoplasm and infection. Neuroradiology. 1993;35(4):288–92.PubMedCrossRefGoogle Scholar
  27. 27.
    Onimus M, Papin P, Gangloff S. Results of surgical treatment of spinal thoracic and lumbar metastases. Eur Spine J. 1996;5(6):407–11.PubMedCrossRefGoogle Scholar
  28. 28.
    Panjabi M, White A. Basic biomechanics of the spine. Neurosurgery. 1980;7(1):76–93.PubMedCrossRefGoogle Scholar
  29. 29.
    Rades D, Rudat V, Veninga T, Stalpers L, Basic H, Karstens J, Hoskin P, Schild S. A score predicting posttreatment ambulatory status in patients irradiated for metastatic spinal cord compression. Int J Radiat Oncol Biol Phys. 2008;72(3):905–8.PubMedCrossRefGoogle Scholar
  30. 30.
    Sahgal A, Larson D, Chang E. Stereotactic body radiosurgery for spinal metastases: a critical review. Int J Radiat Oncol Biol Phys. 2008;71(3):652–5.PubMedCrossRefGoogle Scholar
  31. 31.
    Sørensen P, Helweg-Larsen S, Mouridsen H, Hansen H. Effect of high-dose dexamethasone in carcinomatous metastatic spinal cord compression treated with radiotherapy: a randomized trial. Eur J Cancer. 1994;30(1):22–7.CrossRefGoogle Scholar
  32. 32.
    Spiller W. Rapidly progressive paralysis associated with carcinoma. Arch Neurol Psychiatr. 1925;13(1): 471–7.CrossRefGoogle Scholar
  33. 33.
    Ushio Y, Posner R, Posner J, Shapiro W. Experimental spinal cord compression by epidural neoplasms. Neurology. 1977;27(5):422–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Van der Linden Y, Dijkstra S, Vonk E, Marijnen C, Leer J. Prediction of survival in patients with metastases in the spinal column. Cancer. 2005;103(2):320–8.PubMedCrossRefGoogle Scholar
  35. 35.
    Wong D, Fornasier V, MacNab I. Spinal metastases: the obvious, the occult, and the impostors. Spine. 1990;15(1):1–4.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Critical Care MedicineThe University of Texas M.D. Anderson Cancer CenterHoustonUSA

Section editors and affiliations

  • Yenny Cardenas
    • 1
  1. 1.Critical Care DepartmentUniversidad del Rosario Hospital Universitario Fundacion Santa Fe deBogotaColombia

Personalised recommendations