Metastatic spinal cord compression: diagnosis and management

Between five and 10 in every 200 patients with terminal cancer will have metastatic spinal cord compression (MSCC) within their last two years of life. It is an oncological emergency.1 2 MSCC is caused by compression of the dural sac and its contents (spinal cord or cauda equina) by an extradural or intradural mass,3 and it leads to irreversible neurological damage such as paraplegia or tetraplegia depending on the level of the lesion. Extradural masses are the more common, and their causes and presentation are the focus of this review.

Haematogenous spread with bony metastasis to the vertebral spine causes collapse and compression, accounting for over 85% of MSCC.4 5 However, local tumour extension into the spinal cord and deposition of tumour cells directly within the spinal cord from a distant tumour are two other recognised mechanisms.6 7

Early diagnosis and treatment are essential to prevent permanent neurological damage, so early recognition by non-specialists coupled with rapid referral pathways and treatment are required.