[Epidural metastases at the spinal level. Clinical study of 82 cases]

This is a retrospective review of 82 cases of spinal epidural metastasis. A warning vertebral or radicular pain was present in 85% of the cases. In 33% of the patients, who complained only of pain without any neurological deficit, a complete myelographic block was already present. It is thus of prime importance not to neglect a vertebro-radicular pain in cancer patients, and even in patients without known cancer since the epidural metastasis was the first manifestation of the neoplasm in 30% of our cases. The indications for myelography are defined. The functional result (i.e. ability to walk) after treatment depends on the neurological state before treatment. In our series, total paraplegia was always irreversible. Early diagnosis and treatment are thus very important. The surgical treatment alone is judged insufficient. We were not able to prove the superiority of one of the following therapeutic modalities: laminectomy followed by radiotherapy or radiotherapy alone. Radiotherapy is indicated in all cases, often as the sole treatment. The indications for surgery are defined; they are based on our own experience and the literature. High dose steroids are indicated as adjuvant therapy.