Bilsky ESCC Scale (Epidural Spinal Cord Compression)
The BILSKY EPIDURAL SPINAL CORD COMPRESSION (ESCC) SCALE grades how far a spinal metastasis has encroached on the canal, assessed on axial T2-weighted magnetic resonance imaging, at the site of most severe canal compromise.
Open the calculator → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- The ESCC grade as a LABEL, not a number
- 1c
- OPTIONAL spinal level
- C1 to T2
Result: low grade
The tool opens with these values already filled in. Replace them with your own.
What the result means
- Grade 0
- Bone involvement alone, no epidural disease.
- Grade 1a
- Epidural impingement WITHOUT deformation of the thecal sac.
- Grade 1b
- Deformation of the thecal sac WITHOUT cord abutment.
- Grade 1c
- Deformation WITH cord abutment, no compression. The LAST low grade.
- Grade 2
- Cord compression WITH CSF still visible. The FIRST high grade.
- Grade 3
- Cord compression WITHOUT visible CSF.
- NOT numbers
- parseInt maps 1a, 1b and 1c ALL to 1. Never average, sum or store as an integer. A "mean ESCC grade" is meaningless.
- The split
- Low = 0 to 1c, high = 2 to 3. FOUR of six grades are low; the boundary is abutment vs compression, INSIDE grade 1.
- Not neurology
- Severity of paralysis was NOT correlated with the grade. Grade 3 can have normal power; 1b can be severely impaired.
- Level matters
- C1-T2 threshold is grade 1b; T3-L5 is 1c. The same grade means different things, and the scale carries NO level information.
- Imaging
- Axial T2 MRI at the site of MOST SEVERE compromise. A sagittal or CT reading is not this grade.
- Scope
- Grades an IMAGE. Does not diagnose the syndrome, measure function, or indicate surgery/radiotherapy/steroids. A TIME-CRITICAL emergency.
What you enter
- The ESCC grade as a LABEL, not a number.
- OPTIONAL spinal level.
Full field descriptions
- The ESCC grade as a LABEL, not a number [0 = Bone involvement alone, with no epidural disease; 1a = Epidural impingement WITHOUT deformation of the thecal sac; 1b = Deformation of the thecal sac WITHOUT spinal cord abutment; 1c = Deformation of the thecal sac WITH spinal cord abutment, but no cord compression; 2 = Spinal cord compression WITH cerebrospinal fluid still visible around the cord; 3 = Spinal cord compression WITHOUT visible cerebrospinal fluid around the cord]. 1a, 1b and 1c are DISTINCT grades that all parse to the integer 1.
- OPTIONAL spinal level. NOT part of the grade - it changes the interpretation only [c1-t2 = C1 to T2, threshold grade 1b; t3-l5 = T3 to L5, threshold grade 1c]
How this is calculated
Bilsky MH, Laufer I, Fourney DR, et al. Reliability analysis of the epidural spinal cord compression scale. J Neurosurg Spine. 2010;13(3):324-328. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.