Evidence-Based Orthopaedics   |    
Direct Decompressive Surgery and Radiation Therapy Improved Walking Ability in Metastatic Epidural Spinal Cord Compression

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For correspondence:
Dr. R.A. Patchell, Division of
Neurosurgery, University of Kentucky Medical Center,
800 Rose Street, Lexington, KY 40536. E-mail
address: rpatchell@aol.com
Patchell RA, Tibbs PA, Regine WF, Payne R, Saris S, Kryscio RJ, Mohiuddin M, Young B. Direct Decompressive Surgical Resection in the Treatment of Spinal Cord Compression Caused by Metastatic Cancer: A Randomised Trial.
. 2005 Aug 20;366:643-8.

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 May 01;88(5):1169-1169. doi: 10.2106/JBJS.8805.ebo3
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Question: In patients with metastatic epidural spinal cord compression (MESCC), is direct decompressive surgery and radiation therapy more effective than radiation therapy alone?Design: Randomized (allocation concealed)*, unblinded, controlled trial with a median follow-up of 93 to 102 days.*Information provided by author.Setting: 7 centers in the United States.Patients: 101 patients with cancer who were =18 years of age (median age, 60 y; 70% men) and had magnetic resonance imaging evidence of MESCC (true displacement of the spinal cord by an epidural mass), =1 neurological sign or symptom (including pain), and were not totally paraplegic for =48 hours before study entry. Exclusion criteria were compression of only the cauda equina or spinal roots; multiple discrete compressive lesions; radiosensitive tumors such as lymphomas, leukemia, multiple myeloma, and germ-cell tumors; preexisting or concomitant neurological problems not related to MESCC; previous MESCC; previous spinal radiation precluding receipt of the study dose; poor medical status precluding surgery; or expected survival of <3 months. Follow-up was 100%.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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