Surgical management of spinal epidural disease: an update.

Management of spinal cord compression from metastatic malignant disease remains unsatisfactory. Results of surgical decompression are at best less than those of radiation therapy alone. However, new surgical approaches now focus on removing the anterior-situated tumor tissue which produces neural compression in about 85% of the cases. The results of these procedures that allow removal of the ventrally compressing tumor show significant improvement in the management of patients with spinal epidural disease. We review the surgical strategy of these new approaches and the attendant results.