Synopsis
Recognise cord or cauda-equina compromise before irreversible neurological loss, protect the spine, obtain whole-spine MRI within the emergency window and coordinate definitive surgery, radiotherapy and cancer care.
- MSCC is cord or cauda-equina compression by epidural tumour, vertebral collapse or pathological fracture; neurological function at definitive treatment is the strongest practical predictor of recovery.
- Key symptoms are severe progressive spinal or radicular pain, pain on movement or strain, weakness, gait change, sensory loss and new bladder or bowel dysfunction.
- Contact the named MSCC pathway immediately; do not send a patient with neurological signs through a routine back-pain or outpatient cancer referral.
Key red flags
Progressive bilateral or unilateral limb weakness, gait failure or falls with spinal pain requires emergency MSCC assessment.
Heavy legs, focal weakness, spasticity, hyperreflexia, extensor plantar responses, poor balance or inability to walk indicates long-tract compromise.
Investigation priorities
Confirm compression, level, number of lesions, neural signal and vertebral or epidural anatomy for definitive planning.
Management branches
Cancer coexists with suspicious spinal pain, neurological symptom or sphincter change.
- Contact the named MSCC coordinator or on-call oncology and spinal service immediately and communicate time of onset, walking status, neurological findings, pain and current cancer treatment.
- Assess ABCDE, give analgesia, map motor, sensory and bladder function and protect the spine when movement-provoked pain or instability is suspected.
Key medicines
Dexamethasone for neurological MSCCGive dexamethasone 16 mg orally, or an equivalent parenteral dose, as soon as possible when neurological symptoms or signs are present, then continue 16 mg daily while awaiting surgery or radiotherapy before a specialist-guided taper.
Opioid analgesiaFor severe pain in an opioid-naive adult, a common starting approach is immediate-release oral morphine 2.5 to 5 mg every 4 hours with the same dose available for breakthrough, titrated to response and renal function.