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Practice Guidelines

Spinal metastases and metastatic spinal cord compression: summary of updated NICE guidance

BMJ 2023; 383 doi: https://doi.org/10.1136/bmj.p1973 (Published 18 October 2023) Cite this as: BMJ 2023;383:p1973
  1. James E Hawkins, senior health economist1,
  2. Katharina Dworzynski, guideline lead1,
  3. Nicholas Haden, consultant neurosurgeon2
  4. on behalf of the guideline committee
  1. 1National Institute for Health and Care Excellence, City Tower, Manchester M1 4BT, UK
  2. 2The Royal National Orthopaedic Hospital, London
  1. Correspondence to: J E Hawkins james.hawkins{at}nice.org.uk

What you need to know

  • Immediately contact the MSCC coordinator if a person with a past or current diagnosis of cancer presents with the symptoms or signs of cord compression

  • Start immobilisation without delay for suspected or confirmed MSCC and neurological symptoms or signs suggestive of spinal instability to minimise weight bearing by the spine, but also seek advice early (within 24 hours) from an expert clinician in order to minimise the duration of immobilisation

  • Prescribe adequate pain relief promptly for people with suspected or confirmed spinal metastases or MSCC and carry out an individualised pain assessment

Metastatic spinal cord compression (MSCC) is a well recognised complication of the spread of cancer to the vertebral column. Metastases to the spinal column occur in 3-5% of all people with cancer1 and can cause pain, vertebral collapse, and spinal cord compression. It is frequently an oncological or surgical emergency. Potential neurological damage can lead to irreversible loss of spinal cord function. Early diagnosis and intervention are necessary to reduce neurological consequences and can be achieved through early recognition and reporting of symptoms, effective referral pathways, urgent investigations, and prompt, appropriate treatment.

The 2008 NICE guideline on MSCC,2 updated in 2012, changed the way services are delivered in the UK. However, stakeholders involved in the 2018 surveillance process highlighted changes in evidence and practice, and where implementation of recommendations had been low. In 2023, a full update of the guidance was therefore undertaken covering the care pathway from presentation to early rehabilitation.

Of particular relevance to healthcare professionals working in primary care, the updated guideline re-emphasise recommendations around coordinated MSCC centres (see box 1 for definition), reducing the amount of time people are unnecessarily immobile, and pain management. They also lower the threshold for seeking advice from an MSCC coordinator, arranging magnetic resonance imaging (MRI), and …

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