Metastatic Epidural Spinal Cord Compression American College of Radiology ACR Appropriateness Criteria METASTATIC EPIDURAL SPINAL CORD COMPRESSION AND RECURRENT SPINAL METASTASIS Expert Panel on Radiation Oncology–Bone Metastases: Simon Shek-Man

Metastatic Epidural Spinal Cord Compression The axial skeleton is a commonly involved site in patients with bone metastases. Progressive spinal metastasis may result in epidural spinal cord compression, and lead to paresis and paralysis if left untreated [1-3]. The treatment of metastatic epidural spinal cord compression is determined by disease factors such as histology, site of disease, extent of epidural disease, and extent of metastases elsewhere. Patient factors such as the neurologic status, Karnofsky Performance Status (KPS), and treatment factors, such as availability of qualified spine surgeon and advanced radiotherapy equipment also have to be considered. Patient’s preferences and goals of care are to be weighed into the treatment plan. Ideally, the patient with epidural spinal cord compression is evaluated by an interdisciplinary team including a combination of radiation oncologists, medical oncologists, spine surgeons, pain medicine specialists, interventional radiologists, physiatrists, and palliative care professionals in a timely fashion to determine the urgency of the clinical scenario [1-3]. Treatment recommendations must take into consideration the risk benefit profiles of surgical intervention and radiotherapy for the particular individual’s circumstance, including neurologic status, performance status, extent of epidural disease, stability of the spine, extra-spinal disease status, and life expectancy [1-3]. In patients with high spinal instability neoplastic score (SINS) [4] or retropulsion of bone fragments in the spinal canal, surgical intervention should be strongly considered. The rate of development of motor deficits from spinal cord compression may be a prognostic factor for ultimate functional outcome [5] and should be taken into account when a treatment recommendation is made.