Lo Simon Shek-Man, Ryu Samuel, Chang Eric L, Galanopoulos Nicholas, Jones Joshua, Kim Edward Y, Kubicky Charlotte D, Lee Charles P, Rose Peter S, Sahgal Arjun, Sloan Andrew E, Teh Bin S, Traughber Bryan J, Van Poznak Catherine, Vassil Andrew D
1 University Hospitals Seidman Cancer Center, Case Western Reserve University , Cleveland, Ohio.
2 Stony Brook University School of Medicine , Stony Brook, New York.
J Palliat Med. 2015 Jul;18(7):573-84. doi: 10.1089/jpm.2015.28999.sml. Epub 2015 May 14.
Metastatic epidural spinal cord compression (MESCC) is an oncologic emergency and if left untreated, permanent paralysis will ensue. The treatment of MESCC is governed by disease, patient, and treatment factors. Patient's preferences and goals of care are to be weighed into the treatment plan. Ideally, a patient with MESCC is evaluated by an interdisciplinary team promptly to determine the urgency of the clinical scenario. Treatment recommendations must take into consideration the risk-benefit profiles of surgical intervention and radiotherapy for the particular individual's circumstance, including neurologic status, performance status, extent of epidural disease, stability of the spine, extra-spinal disease status, and life expectancy. In patients with high spinal instability neoplastic score (SINS) or retropulsion of bone fragments in the spinal canal, surgical intervention should be strongly considered. The rate of development of motor deficits from spinal cord compression may be a prognostic factor for ultimate functional outcome, and should be taken into account when a treatment recommendation is made. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
转移性硬膜外脊髓压迫症（MESCC）是一种肿瘤急症，若不治疗，将会导致永久性瘫痪。MESCC的治疗取决于疾病、患者及治疗相关因素。制定治疗方案时需权衡患者的偏好和护理目标。理想情况下，应由多学科团队迅速对MESCC患者进行评估，以确定临床情况的紧急程度。治疗建议必须考虑到针对特定个体情况进行手术干预和放疗的风险效益情况，包括神经状态、身体状况、硬膜外疾病范围、脊柱稳定性、脊柱外疾病状况以及预期寿命。对于脊柱不稳定肿瘤评分（SINS）高或椎管内有骨碎片后凸的患者，应强烈考虑手术干预。脊髓压迫导致运动功能障碍的发展速度可能是最终功能结局的一个预后因素，制定治疗建议时应予以考虑。美国放射学会适宜性标准是针对特定临床情况的循证指南，由多学科专家小组每三年进行一次审查。指南的制定和审查包括对同行评审期刊上当前医学文献的广泛分析，以及应用成熟的共识方法（改良德尔菲法）由专家小组对成像和治疗程序的适宜性进行评分。在缺乏证据或证据不明确的情况下，可采用专家意见来推荐成像或治疗方法。
