The results of decompression of cord or cauda equina compression from metastatic extradural tumors

The role of decompression in spinal metastases with neurologic deficit is controversial. This series demonstrates that the benefit from decompression depends on the nature of the tumor and the neurologic status of the patient. Prognosis is good for patients with incomplete paraplegia, intact sphincter control, a long duration of neurologic deficit and pain, and a gradual onset of compression. The prognosis is poor in cases with complete paraplegia, loss of sphincter control, a short duration of neurologic deficit and pain, and a sudden onset of compression. Surgery is not advocated for all cases, because many patients are already very ill. Surgery is recommended only for selective cases in which the prognosis is good. However, decompression is only palliative. Posterior decompression is preferred, inasmuch as the surgery is less extensive compared to anterior decompression and fusion.