26th June 2023

Investigation and Management

A full neurological examination followed by imaging is required in all presentations suspicious of a possible spinal lesion. MRI can be used to identify spinal pathologies and aid diagnosis by distinguishing characteristics of the lesion. MRI can also be useful in prognostication and neurosurgical planning.

Whole spine MRI is the first line imaging choice to investigate patients with new back pain with focal neurology, or other red flag features, particularly in those with a history of cancer. If a possible spinal malignancy is identified, a CT chest/abdomen/pelvis is useful for staging to identify any primary lesion or other metastases. Biopsies may be taken for histological diagnosis.

Management of the lesion depends on its aetiology. If there is evidence of metastatic cord compression, the management is with flat bed rest, high-dose dexamethasone with PPI cover, and urgent discussion with clinical oncology for consideration of radiotherapy to the affected area.

The neurosurgical MDT (neurologists, neurosurgeons/spinal surgeons, oncologists, psychologists, neuroradiologists and specialist nurses) are essential in making management decisions and supporting the patient through their diagnosis.