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Lifetime incidence of SCC in cancer patients:1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36 1–6%
Median overall survival of patients with SCC: 3–16 months
SCC as the initial manifestation of cancer: 20–30% of all cases of SCC
SCC as the initial manifestation of cancer:

Lung cancer

Cancer of unknown primary

Non-Hodgkin lymphoma

Multiple myeloma

SCC distribution along spine:

    Thoracic spine:

    Lumbar spine:

    Cervical spine:




Sites of Involvement Percentage of SCC Histology (% Among All Cases)
Extradural metastases: 90–95

Prostate cancer (15–20%)

Breast cancer (15–20%)

Lung cancer (15–20%)

Non-Hodgkin lymphoma (5–10%)

Multiple myeloma (5–10%)

Renal cancer (5–10%)

Intradural masses: 5–10


Nerve sheath tumors

Large leptomeningeal metastases

Transforaminal progression of paravertebral tumor: Uncommon



Primary hematogenous seeding to epidural space: Rare  

The most common mechanisms are:

  • Direct extension into the epidural space of a hematogenous metastasis to a vertebral body

  • Pathologic fracture of a vertebral body infiltrated by a metastatic deposit resulting in cord injury by a bone fragment or spinal instability



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  • Spinal cord compression has been associated with most cancers. Consequently, any patient with cancer and new back pain or a change in character of preexisting back pain should receive appropriate evaluation

  • Differential diagnosis of SCC:

    1. Epidural abscess

    2. Subdural abscess

    3. Hematoma

    4. Herniated disc

    5. Leptomeningeal disease

    6. Hypertrophic arthritic changes

    7. Radiation myelopathy

    8. Myelopathy secondary to intrathecal chemotherapy

  • Suspected spinal cord compression requires immediate imaging studies and consultation with a radiation oncologist and a neurosurgeon

  • Because multiple spinal epidural metastasis are found in one-third of patients it is recommended that the entire spinal cord be imaged, or at least the thoracic and lumbar spine in addition to the symptomatic region


Back pain 95%
Weakness 60–85%
Sensory deficits 40–90%
Autonomic dysfunction 50%
Ataxia 5%
Imaging Studies
Gadolinium-enhanced MRI
  • The standard for diagnosis of spinal cord compression

  • Sensitivity: 93%; specificity: 97%; overall diagnostic accuracy: 95%

CT scan
  • Useful for assessing the degree of bone destruction and whether bone or tumor is causing spinal cord compression

  • Myelography and postmyelogram CT is used for patients in whom MRI is contraindicated (such as patients with pacemakers, mechanical valves, and other metal implants)

  • Myelography is contraindicated in the presence of brain masses, thrombocytopenia, or coagulopathy, and has a small risk of worsening the neurologic deficit from pressure shifts in the event of complete spinal subarachnoid block


Treatment Strategies

  1. Supportive care

    • Pain frequently is ...

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