ICU · Oncology

Malignant spinal cord compression (MSCC)

Also known as Metastatic spinal cord compression (MSCC) · Malignant cord compression · Epidural spinal cord compression · Malignant epidural spinal cord compression (MESCC)

MSCC is an oncologic emergency — compression of the spinal cord or cauda equina by metastatic tumour (most often a vertebral body metastasis extending into the epidural space, via Batson's valveless vertebral venous plexus). Presents with: back pain (1 symptom — progressive, worse on lying/coughing/straining), motor weakness, sensory loss (a level below the compression), and bowel/bladder dysfunction (late, poor prognosis — urinary retention is the classical finding). Diagnosis: whole-spine MRI (gold standard); the Bilsky epidural spinal cord compression (ESCC) scale grades the degree of cord compression and guides the surgical vs radiotherapy decision; the Spinal Instability Neoplastic Score (SINS) grades mechanical instability. Treatment: DEXAMETHASONE 10 mg IV IMMEDIATELY on suspicion (reduces vasogenic oedema) — given BEFORE the MRI, then 4 mg every 6 h — followed by urgent surgical decompression (Patchell: surgery + radiotherapy superior to radiotherapy alone in selected fit, single-level patients) or radiotherapy (8 Gy single fraction for poor prognosis). TIME IS CORD: ambulatory status at presentation is the strongest predictor of outcome — most patients ambulatory before treatment remain ambulatory, while few non-ambulatory patients regain walking; paraplegic at presentation rarely walks again.