The role of surgery in the management of metastatic epidural spinal cord compression (MESCC) has been controversial. Before radiation therapy (RT) became available, surgery (simple laminectomy) was the only treatment. With the introduction of RT, the results with laminectomy plus RT did not appear to be different from the results with radiation alone. Surgical treatment was largely abandoned when several retrospective studies and one small randomized trial failed to find any benefit for laminectomy alone or in combination with RT. However, laminectomy was not the best operation for MESCC. The majority of spinal metastases that cause MESCC are located in the vertebral body, anterior to the spinal cord. A laminectomy (removal of the posterior elements of the spinal column) does not remove tumor and often does not result in immediate decompression. A laminectomy also may cause destabilization of the spine because it is often only the posterior elements that are intact, and removal of these causes instability.