Commentary: Controversies in NICE guidance on metastatic spinal cord compression

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 …