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We analyzed the results of direct decompressive surgery plus stabilization of the vertebrae involved (DDSS) in six non-ambulatory patients with metastatic extradural spinal cord compression (MESCC) due to renal cell carcinoma (RCC). Transcatheter arterial embolization (TAE) was performed prior to surgery to reduce intraoperative blood loss. Radiotherapy and systemic therapy, including cytokine or targeted therapy and zoledronic acid, were added to the surgery. The DDSS procedure was performed successfully in all patients, with an estimated mean blood loss of 1726 mL. After surgery, all patients regained ambulatory function within 2 months. Patients were ambulatory with the use of assisting apparatus for 4–29 months (median 10.5 months). Median overall survival time after surgery was 15 months (range 4–38 months). In conclusion, DDSS with preoperative TAE can be performed safely and significantly improves the ambulatory function of non-ambulatory RCC patients with MESCC.