What are the indications for corticosteroid therapy in the management of MSCC, and how should I initiate this treatment?

Corticosteroid therapy is indicated in the management of metastatic spinal cord compression (MSCC) in several situations:

• For people with neurological symptoms or signs of MSCC, corticosteroids should be offered [1, 1.8.1].
• For people with spinal metastases or MSCC who do not have neurological symptoms or signs, corticosteroids may be considered if they experience severe pain or have a haematological malignancy [1, 1.8.3].
• For people with confirmed haematological malignancy with spinal metastases (with or without neurological symptoms or signs), corticosteroids should be offered [1, 1.8.5].
• Corticosteroids are not routinely offered as part of initial management for people without neurological symptoms or signs, unless it is part of a radiotherapy regimen [1, 1.8.7].

The initiation of corticosteroid treatment should follow these guidelines:

• For people with neurological symptoms or signs of MSCC, offer 16 mg of oral dexamethasone (or an equivalent parenteral dose) as soon as possible [1, 1.8.1]. After the initial dose, continue 16 mg daily for those awaiting surgery or radiotherapy [1, 1.8.1].
• For people with confirmed haematological malignancy with spinal metastases (with or without neurological symptoms or signs), offer 16 mg of oral dexamethasone (or equivalent parenteral dose) as soon as possible [1, 1.8.5]. Further corticosteroid treatment should be discussed with the haematology multidisciplinary team [1, 1.8.5].
• If dexamethasone is given before imaging and MSCC is subsequently ruled out, it should be discontinued [1, 1.8.2].
• After surgery or at the start of radiotherapy, the dexamethasone dose should be gradually reduced until stopped [1, 1.8.1].
• Specialist haematological advice should be sought before starting corticosteroid treatment for people with radiologically suspected lymphoma or myeloma with spinal metastases but without neurological symptoms or signs [1, 1.8.6].
• For people receiving corticosteroid treatment, blood glucose levels should be monitored, and proton pump inhibitor acid suppression should be offered [1, 1.8.8].