Second occurrence of symptomatic metastatic spinal cord compression and findings of multiple spinal epidural metastases.

Abstract

To examine the frequency of initial multiple epidural metastases, and the occurrence of secondary spinal cord compression (SCC). To evaluate the frequency of a recurrent SCC after radiotherapy, and to compare among patients with single and multiple intraspinal metastases the risk of having a second SCC, we followed 107 patients with SCC from a histologically verified solid tumor prospectively with regular neurological examinations until death. Multiple metastases were demonstrated in 37 (35%). Eight (7.5%) patients developed a second occurrence of SCC all in a new location within the spinal canal. The second occurrence of SCC was found with the same frequency in patients with single metastases (7.1%) compared to patients with multiple metastases (8.1%). The median survival time after the diagnosis of spinal cord compression was 3.4 months, while in the group of patients who developed a second occurrence of SCC the median survival time was 9.2 months. Only symptomatic epidural metastases should be irradiated, and that all patients treated for SCC should be followed regularly and observed for development of a second SCC.