{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T13:12:48Z","timestamp":1788786768388,"version":"build-2803163510"},"reference-count":29,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2024,6,21]],"date-time":"2024-06-21T00:00:00Z","timestamp":1718928000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Metastatic spinal cord compression represents a substantial risk to patients, given its potential for spinal cord and\/or nerve root compression, which can result in severe morbidity. This study aims to evaluate the effectiveness of a diagnostic\u2013therapeutic algorithm developed at our hospital to mitigate the devastating consequences of spinal cord compression in patients with vertebral metastases. Materials and Methods: The algorithm, implemented in our practice in January 2022, is based on collective clinical experience and involves collaboration between emergency room physicians, oncologists, spine surgeons, neuroradiologists, radiation oncologists, and oncologists. To minimize potential confounding effects from the COVID-19 pandemic, data from the years 2019 and 2021 (pre-protocol) were collected and compared with data from the years 2022 and 2023 (post-protocol), excluding the year 2020. Results: From January 2022 to December 2023, 488 oncological patients were assessed, with 45 presenting with urgency due to suspected spinal cord compression. Out of these, 44 patients underwent surgical procedures, with 25 performed in emergency settings and 19 cases in elective settings. Comparatively, in 2019 and 2021, 419 oncological patients were evaluated, with 28 presenting with urgency for suspected spinal cord compression. Of these, 17 underwent surgical procedures, with 10 performed in emergency scenarios and 7 in elective scenarios. Comparing the pre-protocol period (years 2019 and 2021) to the post-protocol period (years 2022 and 2023), intrahospital consultations (commonly patients neurologically compromised) for spine metastasis decreased (105 vs. 82), while outpatient consultations increased remarkably (59 vs. 124). Discussion: Accurate interpretation of symptoms within the context of metastatic involvement is crucial for patients with a history of malignancy, whether presenting in the emergency room or oncology department. Even in the absence of a cancer history, careful interpretation of pain characteristics and clinical signs is crucial for diagnosing vertebral metastasis with incipient or current spinal cord compression. Early surgical or radiation intervention is emphasized as it provides the best chance to prevent deficits or improve neurological status. Preliminary findings suggest a notable increase in both the number of patients diagnosed with suspected spinal cord compression and the proportion undergoing surgical intervention following the implementation of the multidisciplinary protocol. The reduced number of intrahospital consultations (commonly patients neurologically compromised) and the increased number of visits of outpatients with vertebral metastases indicate a heightened awareness of the issue, leading to earlier identification and intervention before neurological worsening necessitating hospitalization. Conclusions: A comprehensive treatment planning approach is essential, and our multidisciplinary algorithm is a valuable tool for optimizing patient outcomes. The protocol shows potential in improving timely management of spinal cord compression in oncological patients. Further analysis of the factors driving these changes is warranted. Limitations: This study has limitations, including potential biases from the retrospective nature of data collection and the exclusion of 2020 data due to COVID-19 impact. To enhance the robustness of our results, long-term studies are required. Moreover, the single-center study design may limit the validity of the findings. Further multicenter studies would be beneficial for validating our results and exploring underlying factors in detail.<\/jats:p>","DOI":"10.3390\/medicina60071020","type":"journal-article","created":{"date-parts":[[2024,6,21]],"date-time":"2024-06-21T08:50:08Z","timestamp":1718959808000},"page":"1020","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["The Efficacy of a Multidisciplinary Approach and Diagnostic\u2013Therapeutic Algorithm for Vertebral Metastases with Spinal Cord Compression"],"prefix":"10.3390","volume":"60","author":[{"given":"Rossella","family":"Rispoli","sequence":"first","affiliation":[{"name":"Spine and Spinal Cord Surgery Unit, ASUFC, University Hospital Santa Maria della Misericordia of Udine, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrizia","family":"Giorgiutti","sequence":"additional","affiliation":[{"name":"Spine and Spinal Cord Surgery Unit, ASUFC, University Hospital Santa Maria della Misericordia of Udine, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio","family":"Veltri","sequence":"additional","affiliation":[{"name":"Spine and Spinal Cord Surgery Unit, ASUFC, University Hospital Santa Maria della Misericordia of Udine, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edi","family":"Copetti","sequence":"additional","affiliation":[{"name":"Spine and Spinal Cord Surgery Unit, ASUFC, University Hospital Santa Maria della Misericordia of Udine, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Imbruce\u2019","sequence":"additional","affiliation":[{"name":"Spine and Spinal Cord Surgery Unit, ASUFC, University Hospital Santa Maria della Misericordia of Udine, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgia","family":"Iacopino","sequence":"additional","affiliation":[{"name":"Spine and Spinal Cord Surgery Unit, ASUFC, University Hospital Santa Maria della Misericordia of Udine, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3382-0158","authenticated-orcid":false,"given":"Barbara","family":"Cappelletto","sequence":"additional","affiliation":[{"name":"Spine and Spinal Cord Surgery Unit, ASUFC, University Hospital Santa Maria della Misericordia of Udine, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,6,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/00007632-199001000-00001","article-title":"Spinal Metastases: The Obvious, the Occult, and the Impostors","volume":"15","author":"Wong","year":"1990","journal-title":"Spine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3054","DOI":"10.1200\/JCO.2015.65.1497","article-title":"Characteristics of Patients Who Survived 2 Years after Surgery for Spinal Metastases: Can We Avoid Inappropriate Patient Selection?","volume":"34","author":"Verlaan","year":"2016","journal-title":"J. Clin. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"711","DOI":"10.6004\/jnccn.2005.0041","article-title":"Metastatic Spinal Cord Compression","volume":"3","author":"Schmidt","year":"2005","journal-title":"J. Natl. Compr. Cancer Netw."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"7","DOI":"10.3322\/caac.21387","article-title":"Cancer Statistics, 2017","volume":"67","author":"Siege","year":"2017","journal-title":"CA Cancer J. Clin."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1053\/clon.2002.0098","article-title":"Scottish Cord Compression Study Group: Don\u2019t Wait for a Sensory Level\u2014Listen 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_6","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_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":"15","DOI":"10.1016\/S1470-2045(05)70022-X","article-title":"Malignant Spinal-Cord Compression","volume":"6","author":"Prasad","year":"2005","journal-title":"Lancet Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"902928","DOI":"10.3389\/fonc.2022.902928","article-title":"Multidisciplinary Approach to Patients with Metastatic Spinal Cord Compression: A Diagnostic Therapeutic Algorithm to Improve the Neurological Outcome","volume":"12","author":"Rispoli","year":"2022","journal-title":"Front. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e720","DOI":"10.1016\/S1470-2045(17)30612-5","article-title":"An integrated multidisciplinary algorithm for the management of spinal metastases: An International Spine Oncology Consortium report","volume":"18","author":"Spratt","year":"2017","journal-title":"Lancet Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"3159","DOI":"10.1007\/s00520-019-04831-z","article-title":"Opening Up Disruptive Ways of Management in Cancer Pain: The Concept of Multimorphic Pain","volume":"27","author":"Lemaire","year":"2019","journal-title":"Support. Care Cancer"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1017\/S031716710001177X","article-title":"Contemporary Treatment Strategy for Spinal Metastasis: The \u201cLMNOP\u201d System","volume":"38","author":"Paton","year":"2011","journal-title":"Can. J. Neurol. Sci."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"3072","DOI":"10.1200\/JCO.2010.34.3897","article-title":"Spinal Instability Neoplastic Score: An Analysis of Reliability and Validity from the Spine Oncology Study Group","volume":"29","author":"Fourney","year":"2011","journal-title":"J. Clin. Oncol."},{"key":"ref_14","first-page":"5","article-title":"Instability and Impending Instability of the Thoracolumbar Spine in Patients with Spinal Metastases: A Systematic Review","volume":"38","author":"Weber","year":"2011","journal-title":"Int. J. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1055\/s-0043-103280","article-title":"MRI Sequences in Head & Neck Radiology\u2014State of the Art","volume":"189","author":"Widmann","year":"2017","journal-title":"Rofo"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1002\/jmri.20748","article-title":"Methods and Applications of Diffusion Imaging of Vertebral Bone Marrow","volume":"24","author":"Raya","year":"2006","journal-title":"J. Magn. Reson. Imaging"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1016\/j.ejrad.2007.11.039","article-title":"Detection of Osseous Metastases of the Spine: Comparison of High Resolution Multi-Detector-CT with MRI","volume":"69","author":"Becker","year":"2009","journal-title":"Eur. J. Radiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1867","DOI":"10.1038\/sj.bjc.6605079","article-title":"Suspected Malignant Cord Compression-Improving Time to Diagnosis via a \u2018Hotline\u2019: A Prospective Audit","volume":"100","author":"Allan","year":"2009","journal-title":"Br. J. Cancer"},{"key":"ref_19","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":"2014","journal-title":"QJM"},{"key":"ref_20","unstructured":"National Institute for Health and Care Excellence (2024, April 20). Metastatic Spinal Cord Compression in Adults: Risk Assessment, Diagnosis and Management Clinical Guideline. National Collaborating Centre for Cancer 2008. Available online: https:\/\/www.nice.org.uk\/guidance\/cg75\/evidence\/full-guideline-242052589."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"103274","DOI":"10.1016\/j.otsr.2022.103274","article-title":"Comparison of Open Versus Minimally Invasive Surgery in the Treatment of Thoracolumbar Metastases","volume":"108","author":"Ntilikina","year":"2022","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"884928","DOI":"10.3389\/fonc.2022.884928","article-title":"Posterior Percutaneous Pedicle Screws Fixation Versus Open Surgical Instrumented Fusion for Thoraco-Lumbar Spinal Metastases Palliative Management: A Systematic Review and Meta-Analysis","volume":"12","author":"Perna","year":"2022","journal-title":"Front. Oncol."},{"key":"ref_23","first-page":"167","article-title":"Decompression and Surgical Stabilization in the Palliative Treatment of Vertebral Metastases","volume":"83","author":"Cappelletto","year":"1998","journal-title":"La Chir. Degli Organi Di Mov."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"LBA10004","DOI":"10.1200\/JCO.2017.35.18_suppl.LBA10004","article-title":"SCORAD III: Randomized Noninferiority Phase III Trial of Single-Dose Radiotherapy (RT) Compared to Multifraction RT in Patients (Pts) with Metastatic Spinal Canal Compression (SCC)","volume":"35","author":"Hoskin","year":"2019","journal-title":"J. Clin. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1016\/j.rpor.2015.03.004","article-title":"Spinal Metastases: From Conventional Fractionated Radiotherapy to Single-Dose SBRT","volume":"20","author":"Greco","year":"2015","journal-title":"Rep. Pract. Oncol. Radiother."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1540","DOI":"10.1016\/j.spinee.2019.04.011","article-title":"Delayed Presentation to a Spine Surgeon is the Strongest Predictor of Poor Postoperative Outcome in Patients Surgically Treated for Symptomatic Spinal Metastases","volume":"19","author":"Choi","year":"2019","journal-title":"Spine J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"S408","DOI":"10.1016\/j.annonc.2020.08.503","article-title":"394P Reversing the trend of Friday peak for metastatic spinal cord compression referrals","volume":"31","author":"Adeleke","year":"2020","journal-title":"Ann. Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e14050","DOI":"10.1200\/JCO.2021.39.15_suppl.e14050","article-title":"Reversing the Friday peak in metastatic cord compression referrals: Not as simple as previously thought?","volume":"39","author":"Adeleke","year":"2021","journal-title":"J. Clin. Oncol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1","DOI":"10.47723\/w1ymg293","article-title":"Artificial Intelligence: The Gateway to Better Medical Diagnosis","volume":"20","author":"Hameed","year":"2024","journal-title":"AL-Kindy Coll. Med. J."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/7\/1020\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:02:27Z","timestamp":1760108547000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/7\/1020"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,21]]},"references-count":29,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2024,7]]}},"alternative-id":["medicina60071020"],"URL":"https:\/\/doi.org\/10.3390\/medicina60071020","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,21]]}}}