Advancements in metastatic spinal cord compression treatment: a narrative review of innovations, challenges, and future directions

Objective: To synthesize recent advancements in MSCC treatment, evaluating their efficacy in improving neurological function, pain relief, survival, and quality of life. Background: Metastatic spinal cord compression (MSCC) is an oncologic emergency caused by the progression of cancer to the spine and is prevalent in approximately 3-5% of all cancer patients, with a relatively higher incidence of breast, prostate, and lung cancers. MSCC can lead to irreversible paralysis due to loss of vital sensory and motor functions, thus requiring an immediate diagnosis and treatment. Methods: A systematic PubMed search identified studies published over the past 5 years focusing on advancements in MSCC treatment. Applying the PICO criteria, 132 articles were retrieved, of which 38 met the inclusion criteria after rigorous screening. Result: Effective care of metastatic spinal cord compression (MSCC) includes high-dose corticosteroids, surgery, and radiation therapy. Advancements such as robot-assisted and minimally invasive surgeries enhance surgical outcomes. Emerging technologies, including deep learning models for early detection and automated MRI analysis, improve diagnostic accuracy. Personalized medicine techniques, such as next-generation sequencing (NGS), enable the development of customized therapies tailored to individual tumor characteristics. Innovations such as bioengineered implants provide better imaging compatibility and reduce radiation scattering. Proton therapy delivers targeted radiation with minimal harm to adjacent tissues. Conclusion: Prompt, multimodal treatment is necessary, including corticosteroids, surgery, and radiation therapy to reduce symptoms and enhance patient outcomes. Despite advancements, challenges such as delayed diagnosis and limited access to specialized treatments persist. Precision medicine, AI-based diagnostics, and easier access to clinical trials should be the main areas of future development. Preventing irreparable neurological impairments and improving patient quality of life requires a focus on palliative care and early intervention. Integrating innovative therapies with comprehensive supportive care in a patient-centred study is essential for enhancing neurological function, pain control, and overall quality of life.