Spinal cord compression (SCC) in the setting of bone metastases is a medical emergency. When tumour masses or pathological vertebral fractures compress the spinal cord or nerve roots, patients develop neurological deficits and uncontrollable pain that require immediate clinical assessment and intervention.
Immediate corticosteroid therapy is initiated without delay to reduce cord oedema, alongside urgent MRI to confirm the diagnosis. Further management — determining the respective roles of surgical decompression and radiotherapy — is then guided by the patient's performance status, extent of disease, and number of involved sites. The complete evidence-based regimen and decision algorithm are available in the full protocol.
DOI: 10.1016/j.annonc.2020.07.019
SCC is a medical emergency requiring urgent MRI to confirm the diagnosis.
Patients should start dexamethasone without delay and, if possible, steadily reduce over 2 weeks.
In patients with good performance status, limited disease and a single area of compression, a surgical opinion should be requested to determine suitability for a surgical intervention, followed by radiotherapy.
In patients who are not suitable for surgery, radiotherapy alone is indicated.
When tumour masses and pathological fractures of the vertebra cause compression of the spinal cord and/or nerve roots with neurological deficits or uncontrollable pain, immediate surgical intervention is justified.
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