{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T05:15:16Z","timestamp":1775711716168,"version":"3.50.1"},"reference-count":22,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2021,2,9]],"date-time":"2021-02-09T00:00:00Z","timestamp":1612828800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Introduction: Malignant spinal cord compression (MSCC) is one of the most devastating complications of cancer. This event requires rapid decision-making on the part of several specialists, given the risk of permanent spinal cord injury or death. The goals of treatment in spinal metastases are pain control and improvement of neurological function. There can be challenges in delivering prompt diagnosis and treatment in a secondary care setting. We have reflected on the experience of managing MSCC in a district general setting. Aim: Our retrospective audit identified 53 patients with suspected MSCC who entered the relevant pathway from April 2017 to March 2018 at Medway, United Kingdom (UK). Our audit standards were set out by Medway Maritime Hospital and Maidstone and Tunbridge Wells NHS Trust MSCC working group members, using a combination of published evidence and best practice. Results: The patients with suspected MSCC were 53 and 29 of them (54.7%) had confirmed MSCC. The most common malignancies within the confirmed MSCC were lung (11 patients, 37.9%), breast (5 patients 17.2%), and renal (3 patients, 10.3%), followed by prostate, myeloma and carcinoma of unknown primary (2 patients (6.9%) each), as well as pancreatic, colorectal, lymphoma and, bladder (1 patient (3.4%) each). A magnetic resonance imaging (MRI) scan was performed in 48 patients (90.5%); the majority (31 patients, 64.6%) underwent the MRI within the first 24 h, whereas 3 patients had the investigation between 24 and 72 h from the admission. Among the 29 patients with confirmed MSCC, 6 (20.6%) were treated with surgical decompression, while 20 (69%) received radiotherapy (RT) and 3 (10.3%) best supportive care, respectively. Median time to surgery was 5 days (ranged between 2 and 8 days), whereas for RT 44.4 h (ranged between 24 and 72 h). Finally, all 3 patients that decided on symptom control were referred to a palliative care team within the first 24 h following the MRI scan. Conclusions: MSCC is frequently presented outside tertiary care. This may cause subsequent delays in investigation, diagnosis, and treatment, which can be improved by following a fast track referral pathway.<\/jats:p>","DOI":"10.3390\/jpm11020110","type":"journal-article","created":{"date-parts":[[2021,2,12]],"date-time":"2021-02-12T23:38:44Z","timestamp":1613173124000},"page":"110","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Management of Metastatic Spinal Cord Compression in Secondary Care: A Practice Reflection from Medway Maritime Hospital, Kent, UK"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5402-9875","authenticated-orcid":false,"given":"Sidrah","family":"Shah","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, Medway NHS Foundation Trust, Windmill Road, Gillingham ME7 5NY, Kent, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8164-7292","authenticated-orcid":false,"given":"Mikolaj","family":"Kutka","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Medway NHS Foundation Trust, Windmill Road, Gillingham ME7 5NY, Kent, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathryn","family":"Lees","sequence":"additional","affiliation":[{"name":"Kent Oncology Centre, Maidstone and Tunbridge Wells NHS Trust, Hermitage Lane, Maidstone ME16 9QQ, Kent, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6601-438X","authenticated-orcid":false,"given":"Charlotte","family":"Abson","sequence":"additional","affiliation":[{"name":"Kent Oncology Centre, Maidstone and Tunbridge Wells NHS Trust, Hermitage Lane, Maidstone ME16 9QQ, Kent, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6865-9472","authenticated-orcid":false,"given":"Maher","family":"Hadaki","sequence":"additional","affiliation":[{"name":"Kent Oncology Centre, Maidstone and Tunbridge Wells NHS Trust, Hermitage Lane, Maidstone ME16 9QQ, Kent, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deirdre","family":"Cooke","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Medway NHS Foundation Trust, Windmill Road, Gillingham ME7 5NY, Kent, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cherie","family":"Neill","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Medway NHS Foundation Trust, Windmill Road, Gillingham ME7 5NY, Kent, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matin","family":"Sheriff","sequence":"additional","affiliation":[{"name":"Department of Urology, Medway NHS Foundation Trust, Windmill Road, Gillingham ME7 5NY, Kent, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0273-1723","authenticated-orcid":false,"given":"Afroditi","family":"Karathanasi","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Medway NHS Foundation Trust, Windmill Road, Gillingham ME7 5NY, Kent, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2512-6131","authenticated-orcid":false,"given":"Stergios","family":"Boussios","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Medway NHS Foundation Trust, Windmill Road, Gillingham ME7 5NY, Kent, UK"},{"name":"King\u2019s College London, Faculty of Life Sciences &amp; Medicine, School of Cancer &amp; Pharmaceutical Sciences, London SE1 9RT, UK"},{"name":"AELIA Organization, 9th Km Thessaloniki-Thermi, 57001 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,2,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1053\/clon.2002.0098","article-title":"Don\u2019t Wait for a Sensory Level\u2013Listen to the Symptoms: A Prospective Audit of the Delays in Diagnosis of Malignant Cord Compression","volume":"14","author":"Levack","year":"2002","journal-title":"Clin. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"151","DOI":"10.4997\/jrcpe.2019.217","article-title":"Malignant spinal cord compression","volume":"49","author":"Macdonald","year":"2019","journal-title":"J. R. Coll. Physicians Edinb."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1093\/qjmed\/hct244","article-title":"Malignant spinal cord compression: NICE guidance, improvements and challenges","volume":"107","author":"Savage","year":"2013","journal-title":"QJM Int. J. Med."},{"key":"ref_4","unstructured":"National Institute for Health and Care Excellence (2021, January 13). Metastatic Spinal Cord Compression in Adults: Risk Assessment, Diagnosis and Management Clinical Guideline. Available online: https:\/\/www.nice.org.uk\/guidance\/cg75\/evidence\/full-guideline-242052589."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1613","DOI":"10.1200\/JCO.1998.16.4.1613","article-title":"Emergency treatment of malignant extradural spinal cord compression: An evidence-based guideline","volume":"16","author":"Loblaw","year":"1998","journal-title":"J. Clin. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1038\/sc.1993.61","article-title":"Factors related to the outcome of inpatient rehabilitation in patients with neoplastic epidural spinal cord compression","volume":"31","author":"Hacking","year":"1993","journal-title":"Spinal Cord"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"4987","DOI":"10.21873\/anticanres.12817","article-title":"Metastatic Spinal Cord Compression: Unraveling the Diagnostic and Therapeutic Challenges","volume":"38","author":"Boussios","year":"2018","journal-title":"Anticancer Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1097\/01.PHM.0000083662.85497.1F","article-title":"Prognostic factors for survival in metastatic spinal cord compression: A retrospective study in a rehabilitation setting","volume":"82","author":"Guo","year":"2003","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"337","DOI":"10.4055\/cios20014","article-title":"Treatment Strategy for Impending Instability in Spinal Metastases","volume":"12","author":"Kim","year":"2020","journal-title":"Clin. Orthop. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1007\/s00590-014-1438-8","article-title":"Management of metastatic spinal cord compression: Awareness of NICE guidance","volume":"24","author":"Brooks","year":"2014","journal-title":"Eur. J. Orthop. Surg. Traumatol."},{"key":"ref_11","first-page":"111","article-title":"An audit of current practice and management of metastatic spinal cord compression at a regional cancer centre","volume":"104","author":"Sui","year":"2011","journal-title":"Ir. Med. J."},{"key":"ref_12","first-page":"i2539","article-title":"Metastatic spinal cord compression: Diagnosis and management","volume":"353","author":"Collis","year":"2016","journal-title":"BMJ"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"a2538","DOI":"10.1136\/bmj.a2538","article-title":"Diagnosis and management of patients at risk of or with metastatic spinal cord compression: Summary of NICE guidance","volume":"337","author":"White","year":"2008","journal-title":"BMJ"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2028","DOI":"10.1200\/JCO.2005.00.067","article-title":"Systematic Review of the Diagnosis and Management of Malignant Extradural Spinal Cord Compression: The Cancer Care Ontario Practice Guidelines Initiative\u2018s Neuro-Oncology Disease Site Group","volume":"23","author":"Loblaw","year":"2005","journal-title":"J. Clin. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1093\/intqhc\/mzm043","article-title":"Metastatic spinal cord compression as an oncology emergency getting our act together","volume":"19","author":"Lee","year":"2007","journal-title":"Int. J. Qual. Health Care"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"324","DOI":"10.3171\/2010.3.SPINE09459","article-title":"Reliability analysis of the epidural spinal cord compression scale","volume":"13","author":"Bilsky","year":"2010","journal-title":"J. Neurosurg. Spine"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2212","DOI":"10.1097\/CCM.0b013e31824e1865","article-title":"Oncologic emergencies","volume":"40","author":"McCurdy","year":"2012","journal-title":"Crit. Care Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"5589","DOI":"10.21873\/anticanres.12893","article-title":"Spinal Ewing Sarcoma Debuting with Cord Compression: Have We Discovered the Thread of Ariadne?","volume":"38","author":"Boussios","year":"2018","journal-title":"Anticancer Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1016\/S0140-6736(05)66954-1","article-title":"Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: A randomised trial","volume":"366","author":"Patchell","year":"2005","journal-title":"Lancet"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1215\/S1152851704000262","article-title":"A meta-analysis of surgery versus conventional radiotherapy for the treatment of metastatic spinal epidural disease","volume":"7","author":"Klimo","year":"2005","journal-title":"Neuro Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1111\/j.1743-7563.2012.01568.x","article-title":"Treatment of spinal cord compression: Are we overusing radiotherapy alone compared to surgery and radiotherapy?","volume":"9","author":"Hutton","year":"2012","journal-title":"Asia Pac. J. Clin. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1383","DOI":"10.1007\/s00586-012-2635-y","article-title":"Effect of timing of surgery on neurological outcome and survival in metastatic spinal cord compression","volume":"22","author":"Quraishi","year":"2012","journal-title":"Eur. Spine J."}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/11\/2\/110\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:21:41Z","timestamp":1760160101000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/11\/2\/110"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,9]]},"references-count":22,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2021,2]]}},"alternative-id":["jpm11020110"],"URL":"https:\/\/doi.org\/10.3390\/jpm11020110","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,9]]}}}