Epidural metastases in prospectively evaluated veterans with cancer and back pain

Abstract

Ninety-five male veterans with cancer and back pain were prospectively evaluated for epidural metastases. The evaluation included vertebral roentgenograms and a myelogram. The most common cancers were lung and prostate. Forty-three percent of the patients had an epidural metastasis, including 73% of the 37 patients with myelopathy and 48% of the 29 patients with radiculopathy. None of the 29 patients who had back pain without radiculopathy or myelopathy had an epidural metastasis. Thirty-seven patients were treated with only radiation therapy and dexamethasone and four also had surgical decompression. Nineteen of the 20 patients who could walk at diagnosis walked after completion of therapy, whereas, only 11 of the 21 patients who were not ambulatory at the time of diagnosis walked after completion of therapy. The probability of surviving 12 months was 73% for patients who could walk after treatment and 9% for nonambulatory patients. Emergency spinal canal imaging is warranted in cancer patients with back pain and signs or symptoms of radiculopathy or myelopathy.

Directed rehabilitation reduces pain and depression while increasing independence and satisfaction with life for patients with paraplegia due to epidural metastatic spinal cord compression

“…Several prior studies of SEM suggested that patients who walk after SEM treatment live longer [9,13,[19][20]. Some of the difference in survival for ambulatory versus nonambulatory patients may have resulted from differences in the aggressiveness of individual cancers [1][2].…”

“…The RT protocol and dexamethasone dose were the same for all subjects reported here. The SEM treatment protocol was similar to the protocols used in several prior studies of SEM [4,9,[12][13][14]. Patients were considered ambulatory if they could walk without human assistance at least 50 feet without stopping.…”

Persistent benefits of rehabilitation on pain and life quality for nonambulatory patients with spinal epidural metastasis

“…Pain control is an important issue for people with cancer, especially epidural cancer [6][7][8][9][10][11]. In studies of SEMs, pain was usually the initial manifestation of the spinal cancer and the most common symptom when the SEMs were recognized [3][4].…”

Spinal Cord Compression

“…Although the question of whether incidentally detected SEMs should be treated has not been definitively answered, radiation oncologists typically include them in treatment ports, and their presence unquestionably affects surgical decision making. Consequently, many authorities recommend either imaging the entire spine cord [11,[29][30][31] or at least the thoracic and lumbar spine in addition to the symptomatic region; asymptomatic epidural deposits are rarely found in the cervical spine [32].…”