Management of malignant spinal cord compression

Abstract

Metastatic cord compression is one of the most serious complications of cancer. It is an emergency that requires rapid decision making involving several specialities, given the risk of permanent spinal cord injury. Patients may present with various clinical signs such as pain and neurological dysfunction with interventions aiming to improve both of these. Diagnosis is made through detailed history and examination followed by specific radiological investigations. The standard of care in most cases is rapid initiation of corticosteroids in combination with either surgical decompression in case of an operable candidate, followed by radiation therapy or radiotherapy alone. This process has recently been improved by the use of decision frameworks such as NOMS (neurologic, oncologic, mechanical, and systemic), to help clinicians direct treatment. This article represents an overview of the pathogenesis, investigations and management of metastatic cord compression. It references up-to-date national guidance and evidence-based protocols which should inform both surgical and nonsurgical clinicians.