Synopsis
Recognise metastatic spinal instability and neurological compression early, activate the NICE emergency pathway and coordinate safe positioning, whole-spine MRI, corticosteroid and definitive surgery or radiotherapy.
- Cancer plus new weakness, gait change, sensory loss or sphincter disturbance is MSCC until proved otherwise and requires immediate coordinator contact.
- Gold-standard imaging is whole-spine MRI, completed urgently and no later than 24 hours whenever metastatic cord compression is suspected.
- Do not use plain spinal radiography to exclude MSCC; CT is used for bony stability or when MRI is contraindicated, with myelography only in specialist settings.
Key red flags
New weakness, falls, gait change, sensory level or limb numbness in a person with current or previous cancer is possible cord compression.
Investigation priorities
Identify all levels of epidural compression, cord signal, marrow disease, fracture and soft-tissue extent.
Management branches
Cancer and new weakness, gait, sensory or bladder or bowel dysfunction indicate possible compression.
- Contact the MSCC coordinator and spinal or oncology service immediately and document the time and neurological baseline.
- Give dexamethasone 16 mg promptly, then 16 mg daily while definitive treatment is awaited, with glucose and gastric protection.
Key medicines
Dexamethasone for neurological MSCCGive 16 mg orally as soon as possible, or an equivalent parenteral dose when oral administration is unsuitable, then continue 16 mg daily while surgery or radiotherapy is awaited.
Omeprazole during high-dose corticosteroid treatmentUse omeprazole 20 mg orally once daily while high-dose dexamethasone is required, adjusting choice and route for interactions, swallowing and local formulary guidance.