Metastatic Spinal Cord Compression – a primer

  • Metastatic spinal cord compression (MSCC) may be the presenting feature of cancer in up to 20% of patients.
  • A history of persistent worsening back pain in a patient with cancer warrants urgent investigation.
  • Immediate MRI of the whole spine is the imaging modality of choice.
  • Patients with a clinical suspicion of MSCC are routinely commenced on corticosteroids, typically oral dexamethasone 8 mg twice daily, although there is limited evidence to support this practice.
  • Although there was no difference in survival, the use of steroids was associated with a significant improvement in ambulatory status at 6 months.
  • Direct decompressive surgical resection followed by radiotherapy has been shown to be superior to radiotherapy alone.
  • Failure of immediate diagnosis and treatment is associated with significant morbidity and compromised quality of life.

MSCC indications

Postgrad Med J 2008;84:418-427 doi:10.1136/pgmj.2007.067033