Metastatic Spinal Cord Compression (MSCC)

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Metastatic Spinal Cord Compression (MSCC)
Mark Pedder
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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!

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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.

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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

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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.

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Radiotherapy
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Decompression Surgery
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Any questions ?