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Metastatic Spinal Cord Compression (MSCC)

Metastatic Spinal Cord Compression (MSCC). Definition. “MSCC is compression of the dural sac and its contents by an extradural tumour mass in the epidural space, either at the level of the spinal cord or cauda equina .”. Drudge-Coates and Rajbabu, 2008. Caused by…. OR.

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Metastatic Spinal Cord Compression (MSCC)

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  1. Metastatic Spinal Cord Compression (MSCC)

  2. Definition “MSCC is compression of the dural sac and its contents by an extradural tumour mass in the epidural space, either at the level of the spinal cord or caudaequina.” Drudge-Coates and Rajbabu, 2008

  3. Caused by… OR Irreversible neurological damage ensues with resulting paraplegia. (Levack et al, 2002).

  4. Background Metastases to the SC occur in 3-5% of all patients with Cancer with… RISK NICE, 2008 & Schiff, 2003

  5. Clinical Features Schiff, 2003

  6. NICE, 2008

  7. Levack et al (2001) found that 77% of patients diagnosed with SCC had an established Δ of cancer, whereas 23% presented with SCC as the first presentation of malignancy.

  8. Outpatient Physiotherapists must have their ears open to the following… Progressive &/or severe unremitting LBP Pain in upper or middle spine Back pain aggravated by straining, coughing or sneezing Localised tenderness over spine Back pain at night Brooks, 1998

  9. Neuro S&S: Radicular pain, limb weakness, ↓mobility, sensory loss, bladder/bowel dysfunction NICE, 2008

  10. Physiotherapy and Cancer Care • Within Cancer Care, Dietz (1981) identified 4 levels of rehabilitation: • Maintain a good QoL through the minimization of complications

  11. The Association of Physiotherapists in Oncology and Palliative Care The aim of the physiotherapist is to assist these individuals to minimize some of the effects which the disease or its treatment has on them (ACPOPC, 1993 as cited in Bancroft, 2003)

  12. NICE Guidelines findings regarding PT availability for MSCC Patients • CCs 48% • SSUs: 48% • PCDs: 56% • CCs 63% • SSUs: 81% • PCDs: 59% • CCs 63% • SSUs: 76% • CCs 93% • SSUs: 90%

  13. SUHT Management Guidelines Immediate Paraplegia present < 24 hours, regardless of onset Established paraplegia PCT Ax is recommended for Mx and/or rehab SUHT, 2007

  14. Key NICE Recommendations • Service configuration and urgency of treatment • Early detection • Imaging • Treatment of spinal metastases and MSCC • Supportive care and rehabilitation NICE, 2008

  15. Recommendations with significant costs : estimated annual incremental costs resulting from ↑ in surgical activityfor treatment & prevention of MSCC £14,023 • Recommendations with significant savings:supportive care and rehabilitation post discharge of patients £ -17,513 • Net resource impact of MSCC guideline £ -3,490

  16. References • Bancroft, M.I., Physiotherapy in Cancer Care: a theoretical approach (2003). Physiotherapy. 89, 12: 729-733. • Brooks, C. Radiation Therapy: Guidelines for Physiotherapist (1998). Physiotherapy. Vol. 84 (8): 387-395. • Dietz, J.H. (1981) Rehabilitation Oncology, John Wiley, New York • Drudge-Coates, L. and Rajbabu, K. Diagnosis and management of malignant spinal cord compression: part 1 (2008). Int. J. of Palliative Nursing. Vol. 14 (3): 110-116. • Loblaw DA, Perry J, Chambers A, Laperriere NJ (2005) Systematic review of the diagnosis and management of malignant extradural spinal cord compression: the Cancer Care Ontario Practice Guidelines Initiative's Neuro-Oncology Disease Site Group. Journal of Clinical Oncology 23: 2028–2037 • NICE Clinical Guideline 75. Metastatic Spinal Cord Compression: Diagnosis and management of adults at risk of and with metastatic spinal cord compression (2008). • Schiff, D. Spinal Cord Compression (2003). Neurol. Clin. N. Am. 21: 67-86 • The Palliative Care Handbook: Advice on Clinical Management (6th Ed.) CMH, SUHT (2007).

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