Spinal metastases and metastatic spinal cord compression

Context

Metastases to the spinal column are diagnosed in around 16% of all people with cancer and may cause pain, vertebral collapse and spinal cord or root compression. More than 4,000 people present annually in England and Wales with spinal metastases. The NHS estimates that by 2028, around 55,000 more people per year are expected to live at least 5 years with a cancer diagnosis, which is likely to increase the number of people needing timely, appropriate and evidence-based management of spinal metastasis.

The 2008 NICE guideline on metastatic spinal cord compression changed the way services are delivered and care provided for people living with cancer who present with disease that involves the spinal column, and have vertebral collapse or neural compression. However, stakeholders involved in the 2018 surveillance process highlighted changes in evidence and management that necessitated a full review and update of the guideline.

This review has been undertaken against the backdrop of hugely burdened cancer services, the consequences of the COVID-19 pandemic but also with the future hope offered by the cancer alliances in England (and the equivalent local partnerships elsewhere), integrated care boards and the cancer ambitions within the NHS Long Term Plan.

In this guideline, the needs of adults, presenting with spinal metastases, direct malignant infiltration of the spine or metastatic spinal cord or root compression have been considered, covering the care pathway from presentation to early rehabilitation.