Malignant spinal cord compression (MSCC) is one of the most dreaded complications of metastatic cancer. MSCC can be divided into intradural (intramedullary and leptomeningeal) and extradural (Malignant Extradural Spinal Cord Compression [MESCC]).^[1] Its natural history, if untreated, is usually one of relentless and progressive pain, paralysis, sensory loss, and sphincter dysfunction.^[2]

A population-based study of cancer patients reported that 2.5% (n = 3,458) of all cancer patients who died from their disease between 1990 and 1995 had at least one admission for MSCC.^[3] The incidence of MSCC varied widely by primary cancer site, from 7.9% in patients with myeloma to 0.2% in patients with pancreatic cancer.^[3]

In 1998 and again in 2005, our group published evidence-based clinical practice guidelines for the diagnosis and management of MESCC.^{[2] and [4]}