Patchell Criteria Metastatic epidural spinal cord compression

Surgical decompression has proven to be beneficial if a patients meets these criteria:

Inclusion

Tissue-proven cancer, not of CNS or spinal column origin Radiographic spinal cord displacement

= 1 neurological sign, symptom or pain

Single area (one level or multiple contiguous spinal levels) Estimated survival >= 3 months Exclusion

Radiosensitive tumors: lymphoma, leukaemia, multiple myeloma, germ-cell tumor Paraplegic >48h for study entry Only cauda or root compression Prior radiation (if study dose of 10x 3Gy is contraindicated) Indication

Patients with metastatic epidural spinal cord compression treated with direct (<24h after randomisation) decompressive surgery plus postoperative radiotherapy retain the ability to walk for longer and regain the ability more often than do patients treated with radiotherapy alone.

Reference: Patchell et al. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet (2005) vol. 366 (9486) pp. 643-8