Treatment of spinal cord compression: are we overusing radiotherapy alone compared to surgery and radiotherapy?

Hutton, Jonathon; Leung, John

doi:10.1111/j.1743-7563.2012.01568.x

Cited by 4 publications

(2 citation statements)

References 26 publications

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“…15,16 Farther afield, the failure to consult surgeons has also led to a predilection toward initial treatment with radiotherapy despite evidence to the contrary. 14, 17 Our results reflect similar behavior. Surgical opinion should be sought on all patients with MSCC as per evidence-based guidelines.…”

Section: Discussionsupporting

confidence: 85%

Management of Metastatic Spinal Cord Compression in Ireland: Are Surgeons Overlooked?

et al. 2018

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Background: The National Institute of Health and Clinical Excellence (NICE) provide a framework of evidencebased guidelines for the management of metastatic spinal cord compression (MSCC). We aimed to compare our center's provision of service to these best practice guidelines and discuss key shortcomings with their implications for the spinal surgeon. Methods: Patients with radiologic evidence of MSCC over a 30-month period were identified using the hospital electronic radiological database. A chart review was performed analyzing MSCC management. Results: Forty-one patients were identified. Pain was the most common presenting complaint, occurring in 76% of patients. Radiotherapy alone was the most common therapy employed (93% of patients). A surgical opinion was sought for 51% of patients. Histological diagnosis of the causative lesion occurred in 5 patients from surgical specimens. Conclusions: Incongruities between NICE guidelines and our practice exist. Early involvement of the spinal surgical services needs to be encouraged. Establishing a histological diagnosis of the spinal lesion should be seen as of therapeutic importance.

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Section: Discussionsupporting

confidence: 85%

Management of Metastatic Spinal Cord Compression in Ireland: Are Surgeons Overlooked?

et al. 2018

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“…Patients should have a prognosis of more than six months to be considered for surgery [7]. However, surgery can lead to complications such as pulmonary embolism, infections including postoperative pneumonia, cerebrospinal fluid leaks, and major bleeding [7,21]. This may account for reluctance of neurosurgeons to operate and explain the findings in our study with 21% of patients receiving surgery at a tertiary care hospital.…”

mentioning

confidence: 78%

Management of Metastatic Spinal Cord Compression in Secondary Care: A Practice Reflection from Medway Maritime Hospital, Kent, UK

Shah

Kutka

Lees

et al. 2021

JPM

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Introduction: Malignant spinal cord compression (MSCC) is one of the most devastating complications of cancer. This event requires rapid decision-making on the part of several specialists, given the risk of permanent spinal cord injury or death. The goals of treatment in spinal metastases are pain control and improvement of neurological function. There can be challenges in delivering prompt diagnosis and treatment in a secondary care setting. We have reflected on the experience of managing MSCC in a district general setting. Aim: Our retrospective audit identified 53 patients with suspected MSCC who entered the relevant pathway from April 2017 to March 2018 at Medway, United Kingdom (UK). Our audit standards were set out by Medway Maritime Hospital and Maidstone and Tunbridge Wells NHS Trust MSCC working group members, using a combination of published evidence and best practice. Results: The patients with suspected MSCC were 53 and 29 of them (54.7%) had confirmed MSCC. The most common malignancies within the confirmed MSCC were lung (11 patients, 37.9%), breast (5 patients 17.2%), and renal (3 patients, 10.3%), followed by prostate, myeloma and carcinoma of unknown primary (2 patients (6.9%) each), as well as pancreatic, colorectal, lymphoma and, bladder (1 patient (3.4%) each). A magnetic resonance imaging (MRI) scan was performed in 48 patients (90.5%); the majority (31 patients, 64.6%) underwent the MRI within the first 24 h, whereas 3 patients had the investigation between 24 and 72 h from the admission. Among the 29 patients with confirmed MSCC, 6 (20.6%) were treated with surgical decompression, while 20 (69%) received radiotherapy (RT) and 3 (10.3%) best supportive care, respectively. Median time to surgery was 5 days (ranged between 2 and 8 days), whereas for RT 44.4 h (ranged between 24 and 72 h). Finally, all 3 patients that decided on symptom control were referred to a palliative care team within the first 24 h following the MRI scan. Conclusions: MSCC is frequently presented outside tertiary care. This may cause subsequent delays in investigation, diagnosis, and treatment, which can be improved by following a fast track referral pathway.

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Evaluating ambulatory function as an outcome following treatment for spinal metastases: a systematic review

et al. 2021

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Treatment of spinal cord compression: are we overusing radiotherapy alone compared to surgery and radiotherapy?

Cited by 4 publications

References 26 publications

Management of Metastatic Spinal Cord Compression in Ireland: Are Surgeons Overlooked?

Management of Metastatic Spinal Cord Compression in Ireland: Are Surgeons Overlooked?

Management of Metastatic Spinal Cord Compression in Secondary Care: A Practice Reflection from Medway Maritime Hospital, Kent, UK

Evaluating ambulatory function as an outcome following treatment for spinal metastases: a systematic review

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