Metastatic spinal cord compression:
BMJ 2016; (Published 19 May 2016)
What you need to know
Metastatic spinal cord compression is an oncological emergency and may be the first presentation of a cancer
Magnetic resonance imaging of the whole spine is the investigation of choice
Offer corticosteroids and analgesia and consider spinal stability while the patient is assessed
Timely referral for neurosurgery or radiotherapy, or both, provides better outcomes longer term, but palliative care is the treatment of choice for some patients
Between five and 10 in every 200 patients with terminal cancer will have metastatic spinal cord compression (MSCC) within their last two years of life. It is an oncological emergency.
MSCC is caused by compression of the dural sac and its contents (spinal cord or cauda equina) by an extradural or intradural mass, and it leads to irreversible neurological damage such as paraplegia or tetraplegia depending on the level of the lesion.
Extradural masses are the more common.
Haematogenous spread with bony metastasis to the vertebral spine causes collapse and compression, accounting for over 85% of MSCC. However, local tumour extension into the spinal cord and deposition of tumour cells directly within the spinal cord from a distant tumour are two other recognised mechanisms.
Early diagnosis and treatment are essential to prevent permanent neurological damage, so early recognition by non-specialists coupled with rapid referral pathways and treatment are required.