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

doi:10.1136/bmj.a2538

From trainee to consultant, BMJ Group offers doctors around the world tailored information, special events, learning resources and recruitment services at every step along their career path.

... by doctors, for doctors, for patients
We are open for entries!

Online learning

BMJ Learning

High-quality CME / CPD for doctors and other healthcare professionals. BMJ Learning features hundreds of accredited, peer-reviewed learning modules in text, video, and audio formats. Find out more

Courses and Qualifications

BMJ Masterclasses

BMJ Masterclasses, led by experts, help clinicians to use the latest evidence and recent guidelines in practice and meet their CPD/CME requirements. Find out more

Exam Preparation

The leading provider of online exam preparation, helping over 167,000 healthcare professionals to pass their exams. Find out more

onExamination

Search all BMJ education articles:

From

Limit by

The BMJ iPad app brings you the best of print and online, including live links to the latest news, blogs, video, and podcasts. Get the BMJ iPad app.
You can use bmj.com to help you with your continuing medical education. Find out about CME/CPD credits for BMJ articles
Keep up to date with cardiology: Access the latest cardiovascular medicine resources from across BMJ Group.
Countdown to London 2012: BMJ Group's Olympics portal highlights latest Olympics and sports medicine-themed research, comment and learning

Access to the full text of this article requires a subscription or payment. Please log in or subscribe below.

B D White, consultant neurosurgeon1,
A J Stirling, consultant orthopaedic spinal surgeon2,
E Paterson, general medical practitioner3,
K Asquith-Coe, project manager4,
A Melder, senior researcher 4
on behalf of the Guideline Development Group

¹Nottingham University Hospitals NHS Trust, Queen’s Medical Centre, Nottingham NG7 2UH
²Royal Orthopaedic Hospital NHS Foundation Trust, Department of Spinal Surgery, Northfield, Birmingham B31 2AP
³Govan Health Centre, Glasgow G51 4BJ
⁴National Collaborating Centre for Cancer, Cardiff CF10 3AF

Correspondence to: B White barrie.white{at}nuh.nhs.uk

Why read this summary?

Metastatic spinal cord compression is thought to affect more than 4000 people each year in the United Kingdom.1 2 Treatment before paralysis is clinically effective and cost effective. 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⇓).

Management of patients with suspected metastatic spinal cord compression

Recommendations

NICE recommendations are based on systematic reviews of best available evidence. When minimal evidence is available, recommendations are based on the guideline development group’s opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

Early recognition and diagnosis

For patients who have cancer and bone metastases or a high risk of developing bone metastases, and for patients with cancer who present with spinal pain, offer information on the symptoms of spinal metastases and metastatic spinal cord compression and what to do and whom to contact if symptoms develop or worsen while waiting for investigation or treatment. [Based on the experience of the Guideline Development Group]
In patients with cancer, the following suggest spinal metastases: pain in the thoracic or …