Cochrane Summaries

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Interventions for the treatment of metastatic extradural spinal cord compression

George R, Jeba J, Ramkumar G, Chacko AG, Leng M, Tharyan P
Published Online: 
20 January 2010

Cancer that spreads to the spine can compress the spinal cord and nearby spinal structures. If this is not treated, it can lead to pain, disability (including paraplegia) and incontinence. Radiotherapy, steroids and different surgical techniques have been used to reduce the pressure on the spinal cord. It is important to select patients carefully for the different types of treatments as the prognosis and outcome vary greatly depending on the type of cancer and the stage of the illness. This review included trials of radiotherapy, surgery, and steroids to assess if these treatments helped improve walking ability. One study showed that in some common cancers, or where survival was expected to be short, two radiotherapy treatments a week apart were as effective as longer courses of radiation treatment. Another trial showed that with decompressive surgery before radiotherapy compared to radiotherapy alone, more patients maintained the ability to walk and more patients regained their ability to walk. Survival in the radiotherapy alone group was 100 days versus 126 days in those who had surgery first. An older trial reported no additional benefit with the surgical procedure of laminectomy before radiotherapy. It is difficult to give definite recommendations based on these few trials which included a relatively small number of patients, and had different selection criteria. Radiotherapy will be required in the majority of patients, with better results seen in those who have not lost walking ability. Carefully selected patients with a single site of cord compression, who are fit for surgery and have not been paraplegic for more than 48 hours may be considered for decompressive surgery before radiotherapy. High doses of steroids (96 to 100 mg of dexamethasone) significantly increased the risk of serious side effects as compared to moderate doses of 10 to 16 mg dexamethasone or placebo.