21st June 2023

Investigation of suspected MSCC

The approach to managing a patient with suspected MSCC should be standardised and the goal of which is to prevent neurological damage and to further promote neurological function. Typical signs and symptoms which may prompt a clinical review include new onset back pain, particularly non-traumatic back pain with radiculopathy (band-like pain), worsened by movement. Other red-flag signs/symptoms include bilateral lower limb weakness, bilateral shooting leg pains, urinary retention (+/- incontinence due to overflow) and faecal incontinence.

Steps to assessment:

• The patient should be maintained on flat bed rest
• A full neurological examination should be performed including cranial nerves and peripheral nerves.
• Assess for spinal tenderness, using a log-roll technique and perform a digital rectal examination to assess for anal sphincter tone.
• 16 mg Dexamethasone should be administered, either as a STAT dose, or 8 mg BD, ideally morning and lunchtime dosing. This should be co-administered with a PPI.
• A whole spine MRI should be requested, specifically stating that the query is to determine the presence of metastatic spinal cord compression. This must be undertaken within 24 hours of a suspected diagnosis.
• Once a determination of MSCC has been confirmed, treatment should be delivered within 24 hours.
• Spinal Instability Neoplastic Score (SINS) should be calculated to determine the stability of the spine.