Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Immediate Management Steps for Suspected Spinal Cord Compression in Primary Care
- Recognise Indicative Symptoms: Be alert for symptoms and signs such as bladder or bowel dysfunction, gait disturbance or difficulty walking, limb weakness, neurological signs of spinal cord or cauda equina compression, numbness, paraesthesia or sensory loss, and radicular pain NICE NG234. These are particularly concerning in individuals with a past or current diagnosis of cancer, or where cancer is suspected NICE NG234.
- Immediately Contact the MSCC Coordinator: If a person with a past or current diagnosis of cancer presents with the symptoms or signs of cord compression, immediately contact the Metastatic Spinal Cord Compression (MSCC) coordinator NICE NG234. This situation should be treated as an oncological emergency NICE NG234.
- Initiate Immobilisation Without Delay: For individuals with suspected or confirmed MSCC and neurological symptoms or signs suggesting spinal instability, immobilisation should be started without delay, including for transfer to hospital NICE NG234. Immobilisation may also be considered for those with suspected or confirmed spinal metastases or MSCC who experience moderate to severe pain associated with movement NICE NG234.
- Position the Patient Appropriately: If immobilised, the patient should be nursed in a supine position to minimise weight bearing by the spine (lying flat or with partial elevation) NICE NG234. If this position cannot be tolerated due to pain or breathlessness, their position should be adjusted to reduce these symptoms NICE NG234.
- Urgent Oncology Assessment for Suspected Cancer: If a person without a past or current diagnosis of cancer presents with pain characteristics suggesting spinal metastases and cancer is suspected, they should be referred for urgent oncology assessment NICE NG234.