Importance of myelography in early diagnosis of spinal epidural disease.

Epidural metastasis is potentially one of the most disabling complications encountered in oncology. Once paraplegia has been established, only one patient in ten responds to treatment. A series of 16 patients is presented in which early diagnosis and treatment led to improvement in 13 of 16 patients. Most patients present with pain for varying periods (mean 2.2 months) before neurological signs appear. Myelography alone establishes the diagnosis. Spinal radiography correlates well with the block level in two thirds of cases. Radiotherapy, alone or with steroids, increasingly is used in the management of this condition.