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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…

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Metastatic spinal cord compression 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

G Metastatic spinal…

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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…

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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…

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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…

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Metastatic spinal cord compression 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…

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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…

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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…

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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.
G When planning definitive treatment:
­ attempt to establish the primary histology of spinal metastases (by tumour biopsy if necessary)…


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