Purpose of review: Malignant epidural spinal cord compression (MESCC) is a dreaded complication of malignancy and is fortunately not common. Approximately 7% of men dying of prostate cancer will have at least one episode of MESCC during their lifetime. Treatment needs to be individualized and estimating the prognosis is critical to achieving a balance between effectiveness therapy and the burden of treatment.
Recent findings: A consortium of multiple centers has defined prognosis scales, and multiple randomized studies have helped define the optimal dose fractionation schedule for patients getting radiotherapy.
Summary: Simple prognosis scales available to assist the clinician are reviewed. For poor prognosis patients, a single fraction of 8 Gy is just as effective as multiple fractions, however, are much more convenient. For good prognosis patients, surgery and radiation should be considered. For patients not getting surgery, enrollment in clinical trials of single vs. multiple fractions of radiation should be a priority. For high-risk patients, screening strategies are being developed and hold promise for maintaining ambulation throughout the patients' lifetime.