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    Metastatic spinal cord compression (update)

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    1 About this guideline update

    This guideline will update and replace the NICE guideline on metastatic spinal cord compression in adults: risk assessment, diagnosis and management (CG75).

    The guideline will be developed using the methods and processes outlined in developing NICE guidelines: the manual.

    This guideline will also be used to update the NICE quality standard for metastatic spinal cord compression in adults (QS56).

    1.1 Why the update is needed

    New evidence that could affect recommendations was identified through the surveillance process. Topic experts, including those who helped to develop the existing guideline, advised NICE on whether areas should be updated or new areas added. Full details are set out in the surveillance review decision for CG75.

    1.2 Why the guideline is needed

    Metastatic spinal cord compression is a well-recognised complication of progressive vertebral column involvement in the spread of cancer. It is frequently an oncological or surgical emergency.

    Metastatic spinal cord compression occurs when there is pathological vertebral body collapse or direct metastatic tumour progression causing compression of the spinal cord. The cauda equina and nerve roots can be similarly involved. Potential neurological damage can occur, with irreversible loss of spinal cord function in the worst cases. Early diagnosis and intervention are necessary to prevent neurological consequences. To achieve this, early recognition and reporting of symptoms, simple and rapid referral pathways, urgent investigations and prompt, appropriate treatment are all needed.

    1.3 Key facts and figures

    • Metastases to the spinal column occur in 3% to 5% of all people with cancer and may cause pain, vertebral collapse and spinal cord compression. They are most common in people with breast cancer, prostate cancer and lung cancer, in whom incidence may be as high as 19%.

    • People with breast, lung and prostate cancer account for more than 50% of metastatic spinal cord compression presentations. However, it can develop in any type of malignancy in association with vertebral metastases, and occasionally as a result of an isolated extradural tumour, as in lymphoma.

    • The NHS estimates that by 2028, 55,000 more people each year will survive their cancer for 5 years or more. This will potentially lead to more people developing metastatic spinal cord compression and therefore an increase in the resources needed to treat them.

    1.4 Current practice

    Practice has evolved since the publication of the original guideline in 2008. New evidence has been published, some of which may not be consistent with the recommendations, and this has resulted in variation in current practice.

    1.5 Policy, legislation, regulation and commissioning

    The NHS Long Term Plan for Cancer has several ambitions that are relevant to this guideline. The plan aims to create Rapid Diagnostic Centres across the country; introduce a new, faster diagnosis standard to diagnose or rule out cancer within 28 days; and give people with cancer personalised care packages. However, the COVID-19 pandemic had a significant impact on cancer services and treatment, which has created barriers to achieving these aims.