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 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 cerebral spinal fluid (CSF) visible around the cord
- grade 3: spinal cord compression, no CSF visible around the cord Important 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.
- 1. Bilsky MH, Laufer I, Fourney DR, Groff M, Schmidt MH, Varga PP, Vrionis FD, Yamada Y, Gerszten PC, Kuklo TR. Reliability analysis of the epidural spinal cord compression scale. (2010) Journal of neurosurgery. Spine. 13 (3): 324-8. doi:10.3171/2010.3.SPINE09459 - Pubmed
- 2. Bilsky MH, Laufer I, Burch S. Shifting paradigms in the treatment of metastatic spine disease. (2009) Spine. 34 (22 Suppl): S101-7. doi:10.1097/BRS.0b013e3181bac4b2 - Pubmed