Malignant spinal cord compression
Back pain in a person with cancer as the early warning, whole-spine MRI within 24 hours, dexamethasone 16 mg, stability (SINS) and epidural compression (Bilsky) grading, choosing surgery or radiotherapy (Patchell, SCORAD), myeloma and lymphoma, and nursing and rehabilitation care.
Tier 1Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Malignant spinal cord compression (MSCC) is compression of the cord or cauda equina by tumour, usually extending from a vertebral metastasis into the epidural space. It affects about 3 to 5% of people with cancer.
- Back pain comes first. Weakness, sensory loss and sphincter problems are late signs, and by then outcome is worse.
- Function at treatment predicts function after. The aim is to treat while the patient can still walk.
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Sources
- Spinal metastases and metastatic spinal cord compression (NG234)NICE, 2023 (current, November 2026)
- eviQ: malignant spinal cord compression (oncological emergencies)AU/NZCancer Institute NSW
- Therapeutic Guidelines: Oncology and Palliative Care (spinal cord compression)AU/NZTherapeutic Guidelines Ltd
- Patchell RA et al. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet 2005;366:643-8The Lancet, 2005
- Hoskin PJ et al. Effect of single-fraction vs multifraction radiotherapy on ambulatory status among patients with spinal canal compression from metastatic cancer: the SCORAD randomized clinical trial. JAMA 2019;322:2084-94JAMA, 2019
- Fisher CG et al. A novel classification system for spinal instability in neoplastic disease (SINS). Spine 2010;35:E1221-9Spine, 2010
- Bilsky MH et al. Reliability analysis of the epidural spinal cord compression scale. J Neurosurg Spine 2010;13:324-8Journal of Neurosurgery: Spine, 2010
- Sørensen S et al. Effect of high-dose dexamethasone in carcinomatous metastatic spinal cord compression treated with radiotherapy: a randomised trial. Eur J Cancer 1994;30A:22-7European Journal of Cancer, 1994
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy