TREATMENT of epidural involvement by metastatic cancer should be directed to the totality of the invariably present widespread metastatic systemic disease accompanying it. In contrast to patients with metastatic brain disease who frequently have interference with cognitive function, those with epidural compression usually experience the tragedy of remaining fully alert but totally paralyzed. Epidural metastases are particularly devastating in that a growing mass in a closed compartment with a marginal vascular supply can give rise to sudden paraplegia and permanent loss of function; over-whelming nursing problems and untold financial burden result.
Patients with back pain from metastatic neoplasm are usually treated for "bone metastasis," and little consideration is paid to the nuances of the specific symptom complex. "Soft" neurological signs, such as pain or sensory changes in a dermatome (radicular) distribution, or minimal weakness may indicate cord compression. All of our efforts should be directed at detecting compression at this
Gilbert H, Apuzzo M, Marshall L, et al. Neoplastic Epidural Spinal Cord Compression: A Current Perspective. JAMA. 1978;240(25):2771–2773. doi:10.1001/jama.1978.03290250075038
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