Epidural metastases in prospectively evaluated veterans with cancer and back pain

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.