MSCC should be considered in any patient who has new back pain at any level, neurological symptoms and a current or previous history of cancer.
It is an emergency as delayed management threatens mobility and continence – with devastating life-changing impact.
MSCC can occur when cancer has spread to the spine and compresses the spinal cord or cauda equina.
It is most commonly associated with breast, prostate, lung and renal cancer – but can be a complication of any cancer.
Symptoms/signs suggesting Metastatic Spinal Cord Compression:
- severe worsening neck or back pain in a past or current cancer patient
- sudden shooting pains down the legs
- pain aggravated by moving
- localised spinal tenderness
- difficulty walking/falls – ‘heavy legs’
- limb weakness or buckling legs
- numbness and paraesthesiae
- retention of urine and constipation
Symptoms depend on the level of spinal cord compression.
Initial Management for Patients with suspected MSCC:
- Immediate immobilisation – lie flat and log roll
- Urgent MRI Whole Spine within 24 hours/ may have to go to A&E via ambulance for this
- Start high dose Dexamethasone 8mg (PO or IV) twice daily (8am and 12pm) + PPI cover before scan
- Pain needs to be managed
- Most cases will need to be discussed with neurosurgeons. Review usual criteria for consideration of neurosurgery (see criteria section below)
- If the patient is not suitable for neurosurgery they should be referred for consideration of urgent radiotherapy
- All patients should be referred to the palliative care team
Usual criteria for consideration of neurosurgery:
- Localised compression
- Prognosis of >3 months
- Duration of paralysis < 24 hours
Ongoing multi-disciplinary management:
- Continue steroids until advised to taper by neurosurgeons or oncologists
- Monitor blood sugar while on steroids
- Patient will need bowels and bladder monitoring
- If they stop passing urine insert a catheter
- If they are unable to open their bowels they will need a spinal bowel regime e.g. Bisacodyl and Glycerol suppositories every other day
- Physiotherapy, rehabilitation and psychosocial input will be essential depending on the degree of functional loss and potential for rehabilitation