Medication Summary

Dexamethasone administration may acutely preserve neurologic function in patients with epidural spinal cord compression. Opinions regarding dosages vary but recent reviews have recommended doses from 10 to 16 mg, administered either intravenously or orally (IV is more common), followed by 16 mg/day.^{[9, 10]}

Class Summary

These agents have anti-inflammatory properties and cause profound and varied metabolic effects. In addition, they modify the body's immune response to diverse stimuli. With therapy, tumor-associated edema and cord compression, particularly those caused by metastatic tumors, may diminish.

Dexamethasone (Decadron, Hexadrol)

View full drug information

Dexamethasone is used in the treatment of various inflammatory diseases. The mechanism of action in neurologic function is not completely understood. Some physicians prefer higher-dose regimens (100 mg initial bolus), although this has waned in popularity.

Follow-up

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Prasad D, Schiff D. Malignant spinal-cord compression. Lancet Oncol. 2005 Jan. 6(1):15-24. [QxMD MEDLINE Link].
Dugas AF, Lucas JM, Edlow JA. Diagnosis of spinal cord compression in nontrauma patients in the emergency department. Acad Emerg Med. 2011 Jul. 18(7):719-25. [QxMD MEDLINE Link].
Plank C, Koller A, Mueller-Mang C, Bammer R, Thurnher MM. Diffusion-weighted MR imaging (DWI) in the evaluation of epidural spinal lesions. Neuroradiology. 2007 Dec. 49(12):977-85. [QxMD MEDLINE Link].
Bilsky MH, Laufer I, Fourney DR, Groff M, Schmidt MH, Varga PP, et al. Reliability analysis of the epidural spinal cord compression scale. J Neurosurg Spine. 2010 Sep. 13(3):324-8. [QxMD MEDLINE Link].
Sodji Q, Kaminski J, Willey C, Kim N, Mourad W, Vender J, et al. Management of Metastatic Spinal Cord Compression. South Med J. 2017 Sep. 110 (9):586-593. [QxMD MEDLINE Link].
Lee SH, Grant R, Kennedy C, Kilbride L. Positioning and spinal bracing for pain relief in metastatic spinal cord compression in adults. Cochrane Database Syst Rev. 2015 Sep 24. CD007609. [QxMD MEDLINE Link].
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Kumar A, Weber MH, Gokaslan Z, Wolinsky JP, Schmidt M, Rhines L, et al. Metastatic Spinal Cord Compression and Steroid Treatment: A Systematic Review. Clin Spine Surg. 2017 May. 30 (4):156-163. [QxMD MEDLINE Link].
Patchell RA, Tibbs PA, Regine WF, Payne R, Saris S, Kryscio RJ, et al. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet. 2005 Aug 20-26. 366 (9486):643-8. [QxMD MEDLINE Link]. [Full Text].
Spratt DE, Beeler WH, de Moraes FY, Rhines LD, Gemmete JJ, Chaudhary N, et al. An integrated multidisciplinary algorithm for the management of spinal metastases: an International Spine Oncology Consortium report. Lancet Oncol. 2017 Dec. 18 (12):e720-e730. [QxMD MEDLINE Link].
Fehlings MG, Nater A, Tetreault L, Kopjar B, Arnold P, Dekutoski M, et al. Survival and Clinical Outcomes in Surgically Treated Patients With Metastatic Epidural Spinal Cord Compression: Results of the Prospective Multicenter AOSpine Study. J Clin Oncol. 2016 Jan 20. 34 (3):268-76. [QxMD MEDLINE Link].

Media Gallery

Patient with metastatic breast cancer; plain radiograph shows L4 vertebral collapse.
MRI of plain film above showing intrusion of tumor and vertebral collapse into spinal canal.
Patient with renal cell carcinoma; MR shows collapse of a thoracic vertebra with spinal cord impingement.
Axial MR of patient in Media File 3 above with vertebral destruction and spinal cord impingement.

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Author

Jesse Borke, MD, FACEP, FAAEM Associate Medical Director, Department of Emergency Medicine, Los Alamitos Medical Center

Jesse Borke, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Association for Physician Leadership, American College of Emergency Physicians, American College of Physician Executives, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Jeffrey L Arnold, MD, FACEP Chairman, Department of Emergency Medicine, Santa Clara Valley Medical Center

Jeffrey L Arnold, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Physicians

Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP Program Director, Emergency Medicine, Einstein Medical Center Montgomery

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, New York Academy of Medicine, New York Academy of Sciences, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Edmond A Hooker, II, MD, DrPH, FAAEM Associate Professor, Department of Health Services Administration, Xavier University, Cincinnati, Ohio; Assistant Professor, Department of Emergency Medicine, University of Cincinnati College of Medicine

Edmond A Hooker, II, MD, DrPH, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Public Health Association, Society for Academic Emergency Medicine, Southern Medical Association

Disclosure: Nothing to disclose.

J Stephen Huff, MD, FACEP Professor of Emergency Medicine and Neurology, Department of Emergency Medicine, University of Virginia School of Medicine

J Stephen Huff, MD, FACEP is a member of the following medical societies: American Academy of Neurology, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.