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Metastatic Spinal Cord Compression — RACP Adult Medicine MCQ

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ModerateEmergency MedicineMetastatic Spinal Cord CompressionRACP Adult Medicine

A 50-year-old man presents with lower back pain and bilateral leg weakness. MRI shows epidural spinal cord compression at T6 from a metastatic deposit. His prostate is known to be the primary site. He is still ambulatory. What is the most critical initial management?

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Correct answer: D — IV dexamethasone 16 mg stat followed by 4 mg QID

Metastatic spinal cord compression (MSCC) is an oncological emergency. High-dose corticosteroids (dexamethasone 16 mg IV stat, then 4 mg QID) should be commenced immediately to reduce oedema and preserve neurological function. Ambulatory status at presentation is the strongest predictor of post-treatment mobility. Definitive treatment is urgent radiation therapy (within 24 hours) or surgical decompression followed by radiation (Patchell trial showed benefit for surgery in selected patients).

Reference: Cancer Council Australia – 2020 – Metastatic Spinal Cord Compression Guidelines; NICE – 2023 – MSCC Guidelines