spinal cord

spinal cord

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Quick reference guide
Issue date: November 2008
Metastatic spinal cord compression
Diagnosis and management of adults at risk of and
with metastatic spinal cord compression
NICE clinical guideline 75
Developed by the National Collaborating Centre for Cancer

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Metastatic spinal cord compression
About this booklet
This is a quick reference guide that summarises the recommendations NICE has made to the NHS
about metastatic spinal cord compression (NICE clinical guideline 75).
Who should read this booklet?
This quick reference guide is for healthcare professionals and other staff who care for people with
metastatic spinal cord compression.
Who wrote the guideline?
The guideline was developed by the National Collaborating Centre for Cancer, which is based
at the Velindre NHS Trust in Cardiff.…read more

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Metastatic spinal cord compression Contents
Contents
Key priorities for implementation 4
Patient-centred care 5
Patient information 6
Symptoms 6
Imaging 7
Treatment and care 8
Supportive care 12
Managing complications 12
Rehabilitation and care at home 14
Service organisation 14
Implementation tools 16
Further information 16
Introduction
G Metastatic spinal cord compression (MSCC) is defined in this guideline as spinal cord or cauda
equina compression by direct pressure and/or induction of vertebral collapse or instability by
metastatic spread or direct extension of malignancy that threatens…read more

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Metastatic spinal cord compression Key priorities for implementation
Key priorities for implementation
Service configuration and urgency of treatment
G Every cancer network should ensure that appropriate services are commissioned and in place for
the efficient and effective diagnosis, treatment, rehabilitation and ongoing care of patients with
MSCC. These services should be monitored regularly through prospective audit of the care pathway.…read more

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Metastatic spinal cord compression Key priorities for implementation
G Start definitive treatment, if appropriate, before any further neurological deterioration and ideally
within 24 hours of the confirmed diagnosis of MSCC.
G Carefully plan surgery to maximise the probability of preserving spinal cord function without
undue risk to the patient, taking into account their overall fitness, prognosis and preferences.…read more

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Metastatic spinal cord compression Patient information
Patient information
G Give patients with cancer and spinal pain, patients with bone metastases and patients at high risk of
developing bone metastases information explaining what to do and who to contact if they develop
symptoms of spinal metastases or MSCC or if their symptoms progress while waiting for investigation.…read more

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Metastatic spinal cord compression Imaging
Imaging
Magnetic resonance imaging
G Perform magnetic resonance imaging (MRI) of the whole spine in patients with suspected MSCC,
unless contraindicated.
G Include sagittal T1, short T1 inversion recovery and sagittal T2 weighted sequences.
G Perform supplementary axial imaging through any significant abnormality noted on the sagittal scan.
G Configure lists to allow MRI at short notice. Out-of-hours MRI should be available in emergency
situations if immediate treatment is planned.…read more

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Metastatic spinal cord compression Treatment and care
Treatment and care
G The care of patients with MSCC should be determined by senior clinical advisers (clinical oncologists,
spinal surgeons or radiologists with experience and expertise in treating patients with MSCC) in
collaboration with primary tumour site clinicians as required, taking into account the patient's
preferences and condition.…read more

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Metastatic spinal cord compression Treatment and care
Treatments for pain relief and to prevent MSCC
G Decisions on the most appropriate combinations of treatment to relieve pain or prevent paralysis
caused by MSCC (see table 1) should be made by spinal specialists in consultation with primary
tumour site clinicians, and with the full involvement of the patient.…read more

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Metastatic spinal cord compression Treatment and care
Definitive treatment for patients with MSCC
G Start definitive treatment before further neurological deterioration and ideally within 24 hours of
an MSCC diagnosis.…read more

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