Epidural spinal cord compression (ESCC) scale

Epidural spinal cord compression (ESCC) scale has evolved in the era of radiotherapy to qualify the extent of vertebral body metastasis and serve as a guideline as to when intervention (either radiotherapy or surgery) is helpful. 

To this end, Bilsky and colleagues devised a 6-point, MR imaging-based grading system for ESCC 1.

The system uses axial T2-weighted images at the site of most severe compression.


  • grade 0: bone-only disease
  • grade 1:
    • grade 1a: epidural impingement, without deformation of thecal sac
    • grade 1b: deformation of thecal sac, without spinal cord abutment
    • grade 1c: deformation of thecal sac, with spinal cord abutment, without cord compression
  • grade 2: spinal cord compression, with cerebrospinal fluid (CSF) visible around the cord
  • grade 3: spinal cord compression, no CSF visible around the cord

Practical points

  • in the absence of mechanical instability, grades 0, 1a, and 1b are considered for radiation as initial treatment
  • the role of surgery and radiosurgery in patients with grade 1c epidural is controversial with high-dose hypofractionated radiation as a possible SRS option 2
  • grades 2 and 3 describe high-grade ESCC and, unless the tumor is highly radiosensitive, require surgical decompression prior to radiation therapy.

Article information

rID: 67975
Synonyms or Alternate Spellings:
  • ESCC scale

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