Diagnosis and management of patients at risk of or with metastatic spinal cord compression: summary of NICE guidance

Despite the fact that spinal pain is often present for three months and neurological symptoms for two months before paraplegia, almost 50% of patients are unable to walk by the time of diagnosis. 1 3 Recognition is difficult as non-specific back pain is common in both the general population and patients with cancer. 4 5 In addition, 23% of patients with spinal metastases have no prior cancer diagnosis. 1 The added distress and disability caused by paralysis affecting someone already living with cancer cannot be overestimated. 6 This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on how to diagnose and manage patients at risk of or with metastatic spinal cord compression. 7 The algorithm outlines the management of patients with suspected metastatic spinal cord compression (figure ). [...]research should be undertaken on the reasons why patients with metastatic spinal cord compression present late The use of radiotherapy to prevent the development of metastatic spinal cord compression in patients with identified spinal metastases but no pain should be investigated in prospective randomised controlled trials The use of vertebroplasty and kyphoplasty in preventing metastatic spinal cord compression in patients with vertebral metastases should be investigated in prospective comparative studies The use of surgery to prevent the development of metastatic spinal cord compression in patients with identified spinal metastases but no pain should be investigated in prospective randomised controlled trials Further research should investigate (a) what are the most clinically and cost effective regimens of radiotherapy to treat patients with established metastatic spinal cord compression and (b) the use of new techniques, such as intensity modulated radiation therapy.