Patchell criteria

Metastatic epidural spinal cord compression

Surgical decompression has proven to be beneficial if a patients meets these criteria:

Inclusion

• Tissue-proven cancer, not of CNS or spinal column origin
• Radiographic spinal cord displacement
• >= 1 neurological sign, symptom or pain
• Single area (one level or multiple contiguous spinal levels)
• Estimated survival >= 3 months

Exclusion

• Radiosensitive tumors: lymphoma, leukaemia, multiple myeloma, germ-cell tumor
• Paraplegic >48h for study entry
• Only cauda or root compression
• Prior radiation (if study dose of 10x 3Gy is contraindicated)

Indication

Patients with metastatic epidural spinal cord compression treated with direct (<24h after randomisation) decompressive surgery plus postoperative radiotherapy retain the ability to walk for longer and regain the ability more often than do patients treated with radiotherapy alone.

Reference

Patchell et al. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet (2005) vol. 366 (9486) pp. 643-8

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