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    Metastatic spinal cord compression (update)

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    4 Key issues and draft questions

    The key issues and draft questions will be used to develop more detailed review questions, which guide the systematic review of the literature.

    4.1 Information and support

    4.1.1 What information and support is valued by adults with suspected or confirmed spinal metastases, direct malignant infiltration of the spine, or associated spinal cord compression, and by their families and carers?

    4.2 Service configuration and delivery

    4.2.1 What service configuration and delivery arrangements are effective for the investigation and referral of adults with suspected or confirmed spinal metastases, direct malignant infiltration of the spine or associated spinal cord compression?

    4.2.2 What service configuration and delivery arrangements are effective in the management of adults with suspected or confirmed spinal metastases, direct malignant infiltration of the spine or associated spinal cord compression?

    4.3 Recognition

    4.3.1 What symptoms or signs, individually or in combination, or validated clinical tools, suggest the presence of spinal metastatic malignant disease or direct malignant infiltration of the spine?

    4.3.2 What symptoms or signs, individually or in combination, or validated clinical tools, suggest spinal cord compression because of spinal metastatic malignancy or direct malignant infiltration of the spine?

    4.4 Investigations

    4.4.1 How effective are radiological imaging techniques in the diagnosis of spinal metastases, direct malignant infiltration of the spine or associated spinal cord compression?

    4.4.2 How effective are radiological imaging techniques in guiding the management of spinal metastases, direct malignant infiltration of the spine or associated spinal cord compression?

    4.5 Prognostic tools

    4.5.1 What is the prognostic value of validated scoring systems in evaluating spinal metastases or direct malignant infiltration of the spine with or without spinal cord compression in relation to spinal instability?

    4.5.2 What is the prognostic value of validated scoring systems for determining survival in people with spinal cord compression caused by spinal metastases or direct malignant infiltration of the spine?

    4.6 Treatment

    4.6.1 How effective are analgesic interventions in managing pain related to spinal metastases, direct malignant infiltration of the spine or associated spinal cord compression?

    4.6.2 How effective are techniques or methods of immobilisation in managing spinal metastases, direct malignant infiltration of the spine or associated spinal cord compression?

    4.6.3 How effective are bisphosphonate agents in managing spinal metastases, direct malignant infiltration of the spine or associated spinal cord compression?

    4.6.4 How effective is radiotherapy, including both fractionated and unfractionated radiotherapy, for the management of spinal metastases, direct malignant infiltration of the spine or associated spinal cord compression?

    4.6.5 How effective are invasive interventions, such as vertebroplasty, kyphoplasty, ablation and surgery, in managing spinal metastases, direct malignant infiltration of the spine or associated spinal cord compression?

    4.6.6 How effective is corticosteroid therapy in managing the neurological consequences of metastatic spinal cord compression?