Weakness, usually bilateral and symmetric, is present in more than 75 percent of patients at the time of diagnosis and may be rapidly progressive. Autonomic dysfunction of the bladder or bowels is a late sign of epidural compression. The duration and severity of neurologic dysfunction before the initiation of treatment are strong predictors of whether neurologic function can be maintained or restored. Because the prognosis for recovery of neurologic deficits secondary to spinal cord compression is related to the duration and the severity of the deficits at the start of treatment, early diagnosis is crucial. Radiographs of the spine and radionuclide bone scans are usually abnormal in patients with epidural compression but are neither sensitive enough nor specific enough for definitive diagnosis or localization.
Uncertainty remains regarding the most appropriate radiographic evaluation.
Myelography and MRI of the spine are the most sensitive and specific methods of evaluation. However, myelography is invasive and may be uncomfortable for the patient with severe bone pain. MRI of the spine, especially with gadolinium enhancement, is highly sensitive, noninvasive, and more sensitive than myelography in detecting intramedullary metastasis. MRI of the spine should encompass the entire spinal axis and thus may be time consuming and resource intensive. Treatment Treatment of epidural cord compression should be initiated immediately, especially in patients with recent onset of or progression of neurologic dysfunction.