Metastatic spinal cord compression: a review of practice and care

Abstract

Aim and objectives. The aim of this review was to address: (1) How is spinal stability assessed? (2) What is the role of bracing/should braces be used? (3) When is it safe to mobilise the patient? (4) What position should the patient be nursed in? Background. Controversy surrounds the care for patients with metastatic spinal cord compression (MSCC). There is some evidence to indicate that care for patients with MSCC is based on individual clinician preference rather than evidence‐based guidelines which has been shown to cause delays and discrepancies in patient treatment. Design. A structured literature review to synthesise the available evidence about the management of MSCC. Methods. The following databases were searched: Medline, EMBASE, Cochrane Systematic Reviews Database, SIGN (Scottish Intercollegiate Guidelines Network), NICE (National Institute for Clinical Excellence), AMED (Allied and Complementary Medicine), CINAHL (Cumulative Index to Nursing and Allied Health Literature) and BNI (British Nursing Index). Publications were selected from the past 10 years. The search yielded a total of 1057 hits, 755 abstracts were screened, and 73 articles were retrieved and examined. Thirty‐five articles were included. Results. The findings identified a gap and evidence relating to spinal stability, bracing, patient mobilisation, and positioning is limited and may be inconclusive. It is important for patients with a poor prognosis that their preferences and quality of life are considered. Conclusion. Currently, the evidence base to underpin care is limited, and further research in this area is necessary for patients and healthcare professionals alike. Relevance to clinical practice. Patients who suffer from MSCC suffer numerous physical, psychological and social issues. Because of lack of consensus, the current guidelines to inform clinical decision‐making of professional staff are of limited benefit.

Tokuhashi Scoring System has limited applicability in the majority of patients with spinal cord compression secondary to vertebral metastasis

“…Thus, some authors maintain that the surgical decision cri teria should be based on clinical and neurological disor ders instead of prognostic scales 1,20 . Our results support those views.…”

“…The urgent treatment of vertebral metastasis still remains paramount to protect spinal cord vitality 1,2,6,8,11,[14][15][16][17] . Cancer staging data were absent in the majority of our cases until the moment of therapeutic intervention in the spinal cord compression cases.…”

Giant Invasive Spinal Schwannoma With Vertebral Body Collapse In The Cervical Spine: A Case Report

“…giant epidural tumors that erode the vertebral bodies and d extend into the myofascial planes). [9] In this case, the CT revealed C4 vertebral body collapse caused by GISS like spinal metastasis. Therefore, this tumor was not distinguished by clinical presentations, CT, or MRI alone.…”

Survival analysis in patients with metastatic spinal disease: the influence of surgery, histology, clinical and neurologic status

“…Dorsal spinal decompression and stabilization are the most frequent surgical techniques used to treat metastatic disease of the thoracic and lumbar spine 1,2,3,4,5,6,7,8,9,10 . For patients with a solitary spinal metastasis without vertebral canal invasion and who are in good general health with a long life expectancy, tumor resection through en bloc spondylectomy/total vertebrectomy with primary stabilizing instrumentation has been suggested 9,10,11,12,13 . A recent paper reported that candidates for en bloc spondylectomy are not frequently encountered 14,15,16 .…”