MANAGEMENT OF EPIDURAL SPINAL CORD COMPRESSION IN METASTATIC DISEASE: SURGICAL STRATEGIES AND TIMING

Spinal metastasis is a common problem that negatively affects the clinical course of cancer patients. The incidence of spinal metastasis is increasing with the rise in the number of cancer patients and improvements in survival rates. The basic principles of treatment for patients with metastatic epidural spinal cord compression (MESCC) are pain control, preservation of neurological function, and im-provement of the patient’s quality of life. The treatment of metastatic spinal cancer involves a multi-disciplinary approach combining chemotherapy, radiation therapy, and surgery. The goal of surgery in patients with MESCC is to decompress nerve tissues, stabilize the spine, and alleviate pain. Surgical decisions for patients with spinal metastases should be based on a comprehensive evaluation, diagnos-tic tools such as MESCC grade and the Spinal Instablity Neoplastic Scale (SINS) score. Various surgi-cal approaches, including laminectomy, en bloc tumor resection, separation surgery, and percutaneous stabilization procedures, have been described. In addition, the role of resection surgery in combination with radiosurgery and the optimal timing between surgery and radiotherapy are also important issues. This chapter provides a comprehensive overview of the surgical management of ESCC in patients with spinal metastases, emphasizing evaluations and updates on surgical strategies, timing, and multidisci-plinary treatment approaches. This section also discusses the role of endoscopic approaches in spinal oncology and complications associated with surgical strategies.