Published 27 November 2008, doi:10.1136/bmj.a2555
Cite this as: BMJ 2008;337:a2555

Practice

Commentary: Controversies in NICE guidance on metastatic spinal cord compression

Robert Coleman, professor of medical oncology

1 Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield S10 2SJ

r.e.coleman@sheffield.ac.uk

doi:10.1136/bmj.a2538

The first 150 words of the full text of this article appear below.

Spinal cord compression is one of the most devastating complications in advanced malignancy and develops in up to 5% of patients with metastatic bone disease. It often causes misery and profound disability in the last weeks or months of life1 as vertebral fracture and instability, frequently coupled with extra-osseous extension of a soft tissue component, may result in pain and loss of neurological function.

Although spinal cord compression is recognised as an oncological emergency, its management is frequently suboptimal, with late presentation, slow referral for specialist intervention, inadequate availability of urgent and out of hours imaging, lack of surgical expertise, and little or no attempt at rehabilitation.2 Thus many patients present with established, irreversible neurological deficit and are destined to a life spent in a wheelchair or in bed, with increased demands on carers, health care, and social services care.3

In response, the National Institute for Health and Clinical Excellence . . . [Full text of this article]


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Relevant Article

Diagnosis and management of patients at risk of or with metastatic spinal cord compression: summary of NICE guidance
B D White, A J Stirling, E Paterson, K Asquith-Coe, A Melder on behalf of the Guideline Development Group
BMJ 2008 337: a2538. [Extract] [Full Text]

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