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Background
Metastatic epidural spinal cord compression presents in 5–10% of patients with cancer and is becoming more common as advancement in cancer treatment prolongs survival. It represents an oncological emergency because metastatic epidural compression on adjacent neural structures, including the spinal cord, cauda equina, and exiting nerve roots may result in irreversible neurological deficits, pain, and spinal instability. Although the management of metastatic epidural spinal cord compression remains palliative, early diagnosis and intervention may improve outcomes by preserving neurological function, stabilizing the vertebral column, and achieving localized tumor and pain control. Imaging serves an essential role in early diagnosis of metastatic epidural spinal cord compression, evaluation of the degree of spinal cord compression and extent of tumor burden, and preoperative planning. This educational exhibit focuses on imaging features and techniques for diagnosing metastatic epidural spinal cord compression and management guidelines.

Educational Goals / Teaching Points
This educational exhibit will provide an up-to-date overview of the spinal canal compartmental anatomy and pathophysiology of metastatic epidural spinal cord compression, imaging techniques for identifying and characterizing causes of metastatic epidural cord compression, related differential diagnoses, and a brief review of management guidelines.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Metastatic disease to the spine is an increasingly common complication of malignancy as advances in cancer management have increased life expectancy following the initial diagnosis of cancer. Epidural spinal cord compression caused by these lesions is a source of significant morbidity, including neuropathic pain and loss of neurologic function, resulting in significant reduction in patient quality of life. Early clinical recognition of epidural disease is critical in effective treatment, as the severity and duration of neurologic deficit prior to the initiation of treatment are key prognostic factors for degree of recovery. Both diagnosis and management rely heavily on the use of advanced imaging and allow differentiation from nonneoplastic etiologies of spine disease. Contrast-enhanced MRI presently represents the highest available care standard for detecting and characterizing epidural lesions, and for guiding management, which may include surgical decompression and stabilization, radiotherapy, and medical management.

Conclusion
Metastatic epidural spinal cord compression is a common and potentially devastating manifestation of systemic metastatic disease and is becoming an increasingly common oncological emergency as the average age of the population continues to increase in many developed countries. Imaging is central in the diagnosis and evaluation of the extent of spinal metastatic disease and can accurately determine involvement of the epidural space and the degree of spinal cord compression if present. A compartmental approach to assessing and describing imaging features helps refine the differential diagnosis and contributes to optimal management.