Letters Metastatic spinal compression

Coordination improves outcomes in malignant cord compression

BMJ 2009; 338 doi: https://doi.org/10.1136/bmj.a3151 (Published 06 January 2009) Cite this as: BMJ 2009;338:a3151
  1. Pamela Levack, consultant in palliative medicine1,
  2. Lynsay Allan, project manager1,
  3. Lee Baker, statistician2,
  4. Trudy McLeay, radiographer1,
  5. Graeme Houston, consultant radiologist1,
  6. John Dewar, consultant oncologist1,
  7. Sam Eljamel, consultant neurosurgeon1,
  8. Robert Grant, general practitioner3,
  9. Alastair Munro, consultant oncologist1
  1. 1Ninewells Hospital, Dundee DD1 9SY
  2. 2University of Dundee, Dundee
  3. 3Kirkcaldy
  1. pamela.levack{at}nhs.net

    The guidance from the National Institute for Health and Clinical Excellence (NICE) on malignant cord compression argues that a committed, coordinated approach is needed.1 Following the Scottish audit (CRAG),2 all health boards in Scotland were advised to implement rapid referral systems and coordinate the process of early diagnosis. This Macmillan supported initiative has made good progress. The Scottish Cancer Networks have appointed project leads, fast track referral is being implemented, a national minimum dataset has been agreed with the Scottish Government Information and Statistics Division, and a national education toolkit is being developed in collaboration with Macmillan and NHS Scotland.

    In Tayside we have a cord compression hotline with a coordinator who works closely with a senior clinician. The results for the first 100 hotline patients are now available. Half of them had either malignant cord compression (46) or malignant nerve root compression (5).

    The median time from general practitioner or hospital consultant referring to the hotline, to a diagnosis of malignant cord compression was one day. This compares with 66 days in the CRAG audit. The table shows that 23% of patients were unable to walk at all at diagnosis compared with 46% in the CRAG audit. The median duration of symptoms before diagnosis of malignant cord compression was reduced from 89 to 32 days. As patients are more mobile and more comfortable when scanned, magnetic resonance imaging takes less time and is of a better quality.

    Mobility at diagnosis of malignant cord compression in Tayside hotline and CRAG audit

    View this table:

    Our experience with the hotline demonstrates that not only are outcomes improved for patients but also better use is made of hard pressed resources.


    Cite this as: BMJ 2009;338:a3151


    • Competing interests: None declared.


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