What are the key clinical signs and symptoms that suggest a patient may have metastatic spinal cord compression (MSCC)?

Key clinical signs and symptoms suggesting metastatic spinal cord compression (MSCC) include:

• Severe, unremitting back pain that is progressive and mechanical in nature (aggravated by standing, sitting, or moving).
• Back pain worsened by straining activities such as coughing, sneezing, or bowel movements.
• Night-time back pain that disturbs sleep.
• Localized spinal tenderness.
• Neurological symptoms such as limb weakness, numbness, paraesthesia, or sensory loss.
• Signs of spinal cord or cauda equina compression including gait disturbance or difficulty walking.
• Bladder or bowel dysfunction.
• Radicular pain and claudication (muscle pain or cramping in the legs on walking or exercising).

These features should raise suspicion of MSCC, especially in patients with a past or current diagnosis of cancer or suspected cancer, and warrant urgent assessment and referral as MSCC is an oncological emergency ¹.