🧠 Epidural Spinal Cord Compression (ESCC) Classification [Neurosurgery Wiki]

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====== 🧠 Epidural Spinal Cord Compression (ESCC) Classification ======

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The ESCC grading system, developed by Bilsky et al., is based on axial T2-weighted MRI and describes the extent of tumor compression on the thecal sac and spinal cord.
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===== 📐 Grading Scale =====

^ **Grade** ^ **Description** ^
| 0     | Bone-only disease (no epidural involvement) |
| 1a    | Tumor extends into the epidural space without displacing the dura |
| 1b    | Dura displaced, no spinal cord contact |
| 1c    | Spinal cord contact without deformation |
| 2     | Spinal cord compression with CSF visible around the cord |
| 3     | Spinal cord compression with **no visible CSF** around the cord |

===== 🧠 Clinical Significance =====

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**Grades 2–3** = High-grade compression  
→ Often require **surgical decompression** before SBRT to avoid radiation myelopathy and ensure local control.
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* **Grades 0–1c** → Typically amenable to SBRT alone, depending on tumor histology and stability.
* **Grade 2** → Early deformation, CSF still visible → possible candidate for SBRT in radiosensitive tumors.
* **Grade 3** → Complete obliteration of CSF space → often mandates **separation surgery**.

===== 🧪 Imaging Modality =====
* Based on **T2-weighted axial MRI**
* Evaluate the **relationship between tumor, dura, and spinal cord**
* Must be assessed at each involved level for accurate planning