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Suspected metastatic spinal cord compression — MSRA MCQ

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HardMRISuspected metastatic spinal cord compressionMSRA

A 69-year-old man contacts his GP with 10 days of progressively worsening thoracic back pain. He completed androgen-deprivation therapy and radiotherapy for prostate cancer 3 years ago. The pain is now severe, wakes him at night and is worse on coughing and when transferring from sitting to standing. Since yesterday, he has developed bilateral thigh tingling, unsteadiness when walking and difficulty initiating urination. He has no fever or recent trauma. Examination shows a broad-based gait, bilateral hip-flexion weakness (4/5), brisk knee reflexes and reduced pinprick sensation to the upper thighs. He is haemodynamically stable. Which is the most appropriate next management plan?

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

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Correct answer: B — Immediately contact the metastatic spinal cord compression coordinator and arrange whole-spine MRI as soon as possible, and within 24 hours

This is suspected metastatic spinal cord compression (MSCC), an oncological emergency. His previous prostate cancer and severe progressive mechanical/night pain suggest spinal metastatic disease. The new bilateral sensory symptoms, gait disturbance, bilateral upper motor neurone signs, weakness and urinary difficulty are symptoms and signs of cord or cauda equina compression. NICE recommends immediate contact with the MSCC coordinator and MRI as soon as possible, always within 24 hours. MRI should cover the whole spine because metastatic disease may be multifocal and because imaging must define the level and extent of compression for treatment planning. A is inappropriate because CT is the alternative when MRI is contraindicated; he has no stated contraindication. C applies to clinical suspicion of spinal metastases without signs or symptoms of cord compression, for which MRI is performed within 1 week. D wrongly delays emergency coordination and limits imaging to the painful region. E is inappropriate because plain spinal radiographs should not be used to diagnose or exclude spinal metastases or MSCC.

Reference: NICE NG234: Spinal metastases and metastatic spinal cord compression — Recommendations (Updated March 2026) — https://www.nice.org.uk/guidance/ng234/chapter/recommendations NICE Quality Standard QS56: Quality statement 3 — Imaging for adults with suspected metastatic spinal cord compression (Last updated September 2023) — https://www.nice.org.uk/guidance/QS56/chapter/quality-statement-3-imaging-for-adults-with-suspected-metastatic-spinal-cord-compression