Metastatic Spinal Cord Compression

What is metastatic spinal cord compression?

Occurs as a consequence of metastatic disease infiltrating the bones of the spine, it can lead to irreversible neurological damage

What is the pathophysiology of MSCC?

Metastatic cancer (secondary cancer that spread to the bones/tissue of the spinal cord) puts pressure on the spinal cord preventing the nerves from functioning properly through compression.

It can lead to collapse of the vertebral bones to loss of their structural integrity, and can lead to neurological symptoms from invasion or compression at the spinal canal.

What are signs and symptoms of MSCC?

Severe back pain that rapidly escalates and is worse with movement

Banding pain (circulating around the torso)

Pain that is worsened when lying flat or straining (e.g. coughing, emptying the bowels)

Unremitting pain at night that disturbs sleep

Muscle pain or cramps when walking or exercising

Disturbance of gait or coordination - feeling unsteady on the feet inc. difficulty walking, leg weakness, legs giving way

Feeling that arms and hands are not functioning properly - inc. weakness in arms and hands, not being able to grip things properly

Numbness/pins and needles that is new or rapidly getting worse

Systemic illness associated with advanced malignancy

What are risk factors of MSCC?

Many primary cancers - e.g. lung, bowel, breast, prostate, blood

How is MSCC diagnosed?

Considered in all people presenting with signs and symptoms of MSCC that have a history of current, past, or suspected cancer diagnosis

Urgent MRI to confirm diagnosis

How is MSCC managed in the ambulance?

Immobilise, preferably in supine position to minimise weight bearing by the spine

Pain management - NSAIDs as first line analgesic, if contra-indicated a weak opioid such as codeine is suggested

Gain thorough history

• assess for red flags

• inc. past medical history

• SOCRATES

Convey to hospital

How is MSCC managed in hospital?

MRI assessment within 24 hours to diagnose and guide treatment options

If spinal stability is likely start testing this through graded sitting followed by weight bearing

Pain management through non-opioid or opioid analgesics

Corticosteroid therapy to help reduce swelling and pressure on the nerves - e.g. oral dexamethasone

Consider surgical decompression of the spinal cord/ surgical stabilisation of the spine - offer as soon as possible, accounting for the speed of onset and rate of progression of neurological symptoms when determining the urgency of the surgical intervention

Radiotherapy - given as soon as possible within 24 hours to people unsuitable for spinal surgery, offer fertility specialist referral but do not delay urgent treatment

Rehabilitation after to manage lasting symptoms such as inability to walk