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Suspected metastatic spinal cord compression — MSRA MCQ

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ModerateProstate CancerSuspected metastatic spinal cord compressionMSRA

A 74-year-old man with metastatic prostate adenocarcinoma, receiving androgen-deprivation therapy, contacts his GP because of 5 days of worsening thoracic back pain. Today he has difficulty walking, new bilateral leg weakness and numbness to the level of the umbilicus. He has been unable to pass urine for 8 hours. Examination shows Medical Research Council grade 4/5 power in both legs and reduced pinprick sensation below T10. He has type 2 diabetes managed with metformin. What is the most appropriate immediate management plan?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Immediately contact the MSCC coordinator, give dexamethasone 16 mg, and arrange whole-spine MRI as soon as possible and within 24 hours

Explanation lettering: B = shown as A · A = shown as B · D = shown as C · C = shown as D

This presentation is suspected metastatic spinal cord compression (MSCC): he has a current cancer diagnosis together with progressive back pain, gait disturbance, bilateral leg weakness, a sensory level and bladder dysfunction. MSCC is an oncological emergency. The GP should immediately contact the MSCC coordinator so that investigation, transfer and specialist management are coordinated without delay. For neurological symptoms or signs of MSCC, NICE recommends dexamethasone 16 mg orally, or an equivalent parenteral dose, as soon as possible; treatment should not await MRI confirmation. His diabetes requires blood-glucose monitoring, but is not a reason to defer corticosteroid treatment. A proton-pump inhibitor should also be prescribed while he receives corticosteroids. Whole-spine MRI is required as soon as possible and always within 24 hours. B is attractive because MRI confirms the diagnosis, but delaying dexamethasone risks worsening neurological injury. C confuses the pathway for spinal pain without neurological features, for which advice is sought within 24 hours and MRI is performed within 1 week. D is inappropriate because plain spinal radiography cannot diagnose or exclude MSCC. E dangerously delays emergency assessment and treatment.

Reference: Spinal metastases and metastatic spinal cord compression (NG234): Recommendations (Published September 2023; updated March 2026) — https://www.nice.org.uk/guidance/ng234/chapter/Recommendations Spinal metastases and metastatic spinal cord compression (NG234): Recommendations (Published September 2023; updated March 2026) — https://www.nice.org.uk/guidance/ng234/chapter/Recommendations Spinal metastases and metastatic spinal cord compression (NG234): Recommendations (Published September 2023; updated March 2026) — https://www.nice.org.uk/guidance/ng234/chapter/Recommendations