No treatment has been proven to increase the life expectancy. The goals of therapy are pain control and functional preservation. The most important prognostic indicator for spinal metastases is the initial functional score. The ability to ambulate at the time of presentation is a favorable prognostic sign. Loss of sphincter control is a poor prognostic feature and is mostly irreversible.
Immediate treatment is the use of high-dose dexamethasone.
The optimal dexamethasone dose has not been established. In practice it is given as 4 mg q6h after a loading dose of 10 mg. It has the least mineralocorticoid effect and is less likely to be associated with infection or cognitive dysfunction. It increases the risk of myopathy. The latter appears to increase the risk of steroid treatment.