Quality standard

Quality statement 2: Imaging and treatment plans for adults with suspected spinal metastases

Quality statement 2: Imaging and treatment plans for adults with suspected spinal metastases

Quality statement

Adults with spinal pain suggestive of spinal metastases, but with no neurological symptoms or signs, have an MRI of the whole spine and any necessary treatment plan agreed within 1 week of the suspected diagnosis.

Rationale

Adults with spinal pain suggestive of spinal metastases need timely access to imaging that will accurately identify spinal metastases. Whole-spine MRI is central to the diagnosis, staging and planning of treatment. If spinal metastases are suspected, it is essential that investigation, planning and treatment take place before any loss of neurological function occurs. To reduce the risk of avoidable disability for adults with suspected spinal metastases, it is important that an MRI is performed and that treatment is planned by a senior clinician from the multidisciplinary team within 1 week of the suspected diagnosis.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Process

a) Proportion of adults with spinal pain suggestive of spinal metastases, but with no neurological symptoms or signs, who receive an MRI of the whole spine within 1 week of the suspected diagnosis.

Numerator – the number of adults in the denominator who receive an MRI of the whole spine within 1 week of presenting with spinal pain suggestive of spinal metastases, but with no neurological symptoms or signs.

Denominator – the number of adults who present with spinal pain suggestive of spinal metastases, but with no neurological symptoms or signs.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

b) Proportion of adults with spinal metastases confirmed by MRI of the whole spine, but with no neurological symptoms or signs, who have a treatment plan agreed within 1 week of the suspected diagnosis.

Numerator – the number of adults in the denominator who have a treatment plan agreed within 1 week of presenting with spinal pain suggestive of spinal metastases, but with no neurological symptoms or signs.

Denominator – the number of adults with spinal metastases confirmed by MRI of the whole spine, but with no neurological symptoms or signs.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

What the quality statement means for different audiences

Service providers ensure that adequate capacity is available for whole-spine MRI scanning and treatment planning to be undertaken within 1 week for adults with suspected spinal metastases who present with spinal pain but with no neurological symptoms or signs.

Healthcare professionals ensure that they perform an MRI of the whole spine for adults with suspected spinal metastases who present with spinal pain but with no neurological symptoms or signs, and agree any necessary treatment plan within 1 week of the suspected diagnosis.

Commissioners ensure that they commission services that can provide MRI scanning and treatment planning by a senior clinician from the multidisciplinary team within 1 week of the suspected diagnosis of spinal metastases for adults who have spinal pain but no neurological symptoms or signs.

Adults with suspected spinal metastases (who have spinal pain only) have an MRI of their whole spine and, if necessary, have a plan for their treatment organised within 1 week of the suspected diagnosis.

Source guidance

Spinal metastases and metastatic spinal cord compression. NICE guideline NG234 (2023), recommendations 1.1.17, 1.3.3, 1.5.3, 1.5.5 and box 1

Definitions of terms used in this quality statement

Pain characteristics suggestive of spinal metastases

The following symptoms are suggestive of spinal metastases:

  • severe unremitting back pain

  • progressive back pain

  • mechanical pain (aggravated by standing, sitting or moving)

  • back pain aggravated by straining (for example, coughing, sneezing or bowel movements)

  • night-time back pain disturbing sleep

  • localised tenderness

  • claudication (muscle pain or cramping in the legs when walking or exercising).

[Adapted from NICE's guideline on spinal metastases and metastatic spinal cord compression, box 1]