Metastatic Spinal Cord Compression (MSCC)

1. Metastatic Spinal Cord Compression (MSCC) Mark Pedder

2. Definition of MSCC? • Spinal cord or cauda equine compression by direct pressure and / or induction of vertebral collapse or instability by metastatic spread or direct extension that threatens or causes neurological disability (NICE, 2008). • It is an Oncological emergency!

5. Information on MSCC • •5-10% of cancer patients. • •40% of cancer patients with bony mets. • •Breast, Lung, Prostate cancer • •Kidney, thyroid, colon • •77% have a cancer diagnosis • •MSCC first presentation in 23%. • •70% occur in thoracic spine, 20% in cervical spine, 10% in lumbar spine.

6. Signs & Symptoms • Increasing & unexplained pain in neck or spine • Any numbness/ weakness in arms or legs • Difficulty in walking and balancing • Problems with controlling & emptying bladder or bowels • Any muscle loss or lack of tendon reflex

7. MSCC Management • Discuss with on-call registrar and with oncology consultant as soon as possible • Request urgent MRI of whole spine • within 24 hours if any neuro signs present • within a week if spinal pain without any specific neuro symptoms / signs • Administer • dexamethasone 12-16mg po/sc stat • omeprazole 20mg po/IV • morphine 5-10mg po/sc • Then consider whether it is appropriate to treat any further. • Additional therapy may include • Local radiotherapy to the spine • Spinal decompression surgery • If further treatment considered, arrange urgent transfer to Mount Vernon Hospital with the assistance of the appropriate cancer nurse specialist.

8. Radiotherapy

9. Decompression Surgery

10. Any questions ?