Neurology

Metastatic Spinal Cord Compression (MSCC)

Metastatic spinal cord compression is compression of the spinal cord or cauda equina by malignant disease and an oncological emergency; progressive spinal pain, gait change, weakness, sensory loss or bladder/bowel symptoms in someone with current or previous cancer need immediate MSCC-pathway escalation.

Definition

Metastatic spinal cord compression is compression of the spinal cord or cauda equina by metastatic tumour or direct malignant infiltration. It commonly results from vertebral metastasis with epidural extension, vertebral collapse or both, and is an oncological emergency because neurological injury may become permanent.

First principles

Pain is often the first neurological warning

Spinal metastases can cause severe, progressive, mechanical or nocturnal pain before cord or cauda equina dysfunction appears. Pain worsened by coughing, sneezing, bowel movements or movement is particularly concerning. The opportunity to preserve walking and sphincter function is before neurological loss becomes established, so do not wait for paralysis.

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