Diagnosis and management of patients at risk of or with metastatic spinal cord compression: summary of NICE guidance

Metastatic spinal cord compression is thought to affect more than 4000 people each year in the United Kingdom.1 2 Treatment before paralysis is clinically effective and cost effective. Despite the fact that spinal pain is often present for three months and neurological symptoms for two months before paraplegia, almost 50% of patients are unable to walk by the time of diagnosis.1 3 Recognition is difficult as non-specific back pain is common in both the general population and patients with cancer.4 5 In addition, 23% of patients with spinal metastases have no prior cancer diagnosis.1 The added distress and disability caused by paralysis affecting someone already living with cancer cannot be overestimated.6 This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on how to diagnose and manage patients at risk of or with metastatic spinal cord compression.7 The algorithm outlines the management of patients with suspected metastatic spinal cord compression (figure⇓). Management of patients with suspected metastatic spinal cord compression NICE recommendations are based on systematic reviews of best available evidence. When minimal evidence is available, recommendations are based on the guideline development group’s opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets. ### Early recognition and diagnosis