Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Suspected malignant cord compression
Cancer with new neurological deficit, gait loss, sensory change or bladder or bowel dysfunction is MSCC until urgent imaging proves otherwise. Severe mechanical spinal pain may also indicate instability with risk during movement.
Action: Contact the MSCC coordinator or acute oncology team immediately, assess and document neurology, support neutral alignment if instability is suspected, give dexamethasone 16 mg for neurological features, provide analgesia and obtain whole-spine MRI within 24 hours. Discuss surgery and radiotherapy as soon as imaging is available.
Synopsis
Recognise malignant spinal cord or cauda-equina compression before irreversible disability, protect the spine, obtain whole-spine MRI within the correct timeframe and coordinate dexamethasone, surgery, radiotherapy, rehabilitation and goal-concordant supportive care.
Metastatic spinal cord compression is an oncological emergency: new weakness, gait change, sensory loss, radicular pain or bladder and bowel dysfunction in a person with cancer needs immediate MSCC-pathway contact.
Pain often precedes neurological loss. Progressive night pain, movement pain, coughing or straining pain and a band-like radicular quality are high-risk patterns.
First-line examination records power, reflexes, sensory level, gait if safe, saddle sensation, anal function when indicated, bladder retention and spinal tenderness without forcing movement.
Key red flags
New limb weakness, gait disturbance or inability to stand in a person with current or previous cancer is an emergency.
Rapid neurological progression
Declining power, inability to stand or new sphincter dysfunction demands immediate MSCC coordination and imaging rather than routine outpatient referral.
Investigation priorities
01
Immediate neurological and stability assessmentFirst step
Document power, reflexes, sensory level, saddle and sphincter features, gait only if safe, spinal pain, deformity and last functional baseline.
Management branches
Immediate pathwayProtect neurology while obtaining MRI
A person with cancer develops weakness, gait, sensory or sphincter change suggesting MSCC.
Contact the named MSCC service immediately, record neurological baseline and timing, assess instability and support alignment while providing adequate analgesia.
Give dexamethasone 16 mg by a feasible route for neurological symptoms or signs, monitor glucose and obtain whole-spine MRI within 24 hours.
Key medicines
Immediate dexamethasone for neurological MSCCGive 16 mg orally as soon as possible, or an equivalent parenteral dose when oral treatment is unreliable, then continue 16 mg daily while awaiting surgery or radiotherapy and taper after definitive treatment begins.
Goal-matched analgesia during spinal rescueUse regular paracetamol when appropriate plus immediate-release opioid titrated to pain and renal function, converting to a stable regular regimen once requirement is known; add neuropathic treatment only after safety review.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.