Interventions for the treatment of metastatic extradural spinal cord compression in adults

George, Reena; Jeba, Jenifer; Govindaraj, Ramkumar; Chacko, Ari G; Tharyan, Prathap

doi:10.1002/14651858.cd006716.pub2

Cited by 78 publications

(31 citation statements)

References 66 publications

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“…Malignant spinal cord compression is considered an oncologic emergency that can lead to irreversible loss of neurologic function if left untreated (4), with substantial decrements to patient quality of life (5)(6)(7). Corticosteroids followed by radiotherapy (RT) are widely used treatments for MSCC, with evidence that upfront surgery may benefit selected patients (8)(9)(10). Median survival after the diagnosis of MSCC is 3-6 months (11,12), with prognosis depending on primary tumor histology, ambulatory status, and number and site of metastases (13).…”

Section: Introductionmentioning

confidence: 99%

Incidence and Treatment Patterns in Hospitalizations for Malignant Spinal Cord Compression in the United States, 1998–2006

Mak

Lee

Mak³

et al. 2011

International Journal of Radiation Oncology*Biology*Physics

106

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Section: Introductionmentioning

confidence: 99%

Incidence and Treatment Patterns in Hospitalizations for Malignant Spinal Cord Compression in the United States, 1998–2006

Mak

Lee

Mak³

et al. 2011

International Journal of Radiation Oncology*Biology*Physics

106

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“…Cord compression occurs in approximately 5% of all cancer patients[5] and requires emergent decompressive surgery which is considered to be the “gold standard” in tumors which are not specifically radiosensitive. [67] This is also supported by the evidence of regained ambulation after primary radiation therapy which ranged from 18[8] to 51%[9] and primary surgical treatment of MSCC (50[10] –100%). [11] Carefully selected patients in acceptable health conditions with a single site of cord compression, who have not been paraplegic for more than 48 hours, are considered to receive decompressive surgery before radiotherapy.…”

Section: Introductionmentioning

confidence: 81%

“…[11] Carefully selected patients in acceptable health conditions with a single site of cord compression, who have not been paraplegic for more than 48 hours, are considered to receive decompressive surgery before radiotherapy. [6]…”

Section: Introductionmentioning

confidence: 99%

Malignant cord compression: A critical appraisal of prognostic factors predicting functional outcome after surgical treatment

Putz

Middendorp

Pouw

et al. 2010

J Craniovert Jun Spine

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Objectives:Advanced tumor disease and metastatic spinal cord compression (MSCC) are two entities with a high impact on patients’ quality of life. However, prognostic factors on the outcome after primary decompressive surgery are less well-defined and not yet standardized. The aim of this review was to identify prognostic variables that predict functional or ambulatory outcomes in surgically treated patients with symptomatic MSCC.Materials and Methods:We conducted MEDLINE database searches using relevant keywords in order to identify abstracts referring to prognostic factors on ambulatory outcomes in surgically treated MSCC patients. Details of all selected articles were assembled and the rates of ambulation were stratified.Results:Evidence from five retrospective comparative trials and one observational prospective study summarizes different prognostic factors with a positive or negative influence on postoperative ambulatory status. Ambulatory patients maintaining ambulation status after decompression of the spinal cord constituted 62.1%. The overall rate of MSCC patients losing the ability to ambulate was 7.5% compared to 23.5 % who regained ambulation. Preoperative ambulation status, time to surgery, compression fracture and individual health status seem to be the most relevant prognostic factors for ambulatory outcome.Conclusions:There is a lack of standardized prognostic tools which allow predicting outcome in surgically treated patients. A quantitative score consisting of reliable prognostic tools is essential to predict loss and/or regain of ambulation and requires validation in future prospective clinical trials.

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“…15 There was, however, a significant increase in drug-related adverse effects (specifically perforated gastric ulcer, psychoses, and deaths from infections) in patients receiving high-dose treatment. Because of this, the value of high-dose dexamethasone regimens is yet again called into question.…”

Section: Discussionmentioning

confidence: 99%

Corticosteroid Treatment for Metastatic Spinal Cord Compression: A Review

Skeoch

Tobin

Khan

et al. 2017

Global Spine Journal

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Study Design:Narrative review.Objective:Metastatic spinal cord compression (MSCC) is a very frequent complication among cancer patients. Presenting commonly as nocturnal back pain, MSCC typically progresses to lower extremity paresis, loss of ambulatory capabilities, and paraplegia. In addition to standard treatment modalities, corticosteroid administration has been utilized in preclinical and clinical settings as adjunctive therapy to reduce local spinal cord edema and improve clinical symptoms. This article serves as a review of existing literature regarding corticosteroid management of MSCC and seeks to provide potential avenues of research on the topic.Methods:A literature search was performed using PubMed in order to consolidate existing information regarding dexamethasone treatment of MSCC. Of all search results, 7 articles are reviewed, establishing the current understanding of metastatic spine disease and dexamethasone treatment in both animal models and in clinical trials.Results:Treatment with high-dose corticosteroids is associated with an increased rate of potentially serious systemic side effects. For this reason, definitive guidelines for the use of dexamethasone in the management of MSCC are unavailable.Conclusions:It is still unclear what role dexamethasone plays in the treatment of MSCC. It is evident that new, more localizable therapies may provide more acceptable treatment strategies using corticosteroids. Looking forward, the potential for more targeted, localized application of the steroid through the use of nanotechnology would decrease the incidence of adverse effects while maintaining the drug’s efficacy.

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Interventions for the treatment of metastatic extradural spinal cord compression in adults

Cited by 78 publications

References 66 publications

Incidence and Treatment Patterns in Hospitalizations for Malignant Spinal Cord Compression in the United States, 1998–2006

Incidence and Treatment Patterns in Hospitalizations for Malignant Spinal Cord Compression in the United States, 1998–2006

Malignant cord compression: A critical appraisal of prognostic factors predicting functional outcome after surgical treatment

Corticosteroid Treatment for Metastatic Spinal Cord Compression: A Review

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