Patchell Criteria

Metastatic epidural spinal cord compression

Surgical decompression has proven to be beneficial if a patients meets these criteria:


  • Tissue-proven cancer, not of CNS or spinal column origin
  • Radiographic spinal cord displacement
  • >= 1 neurological sign, symptom or pain
  • Single area (one level or multiple contiguous spinal levels)
  • Estimated survival >= 3 months


  • Radiosensitive tumors: lymphoma, leukaemia, multiple myeloma, germ-cell tumor
  • Paraplegic >48h for study entry
  • Only cauda or root compression
  • Prior radiation (if study dose of 10x 3Gy is contraindicated)


Patients with metastatic epidural spinal cord compression treated with  direct (<24h after randomisation) decompressive surgery plus  postoperative radiotherapy retain the ability to walk for longer and  regain the ability more often than do patients treated with radiotherapy  alone.

Reference: Patchell et al. Direct decompressive  surgical resection in the treatment of spinal cord compression caused by  metastatic cancer: a randomised trial. Lancet (2005) vol. 366 (9486)  pp. 643-8