Clinicians who have a patient they are worried about should contact the MSCC co-ordinating service urgently, which is based at The Christie.
Symptoms of spinal cord compression:
- New and persistent localised back or neck pain, chest wall pain or other unexplained atypical pain
- Severe pain in the lower back that gets worse or doesn’t go away
- Pain in the back that is worse when coughing, sneezing or straining
- Back pain that is worse at night
- Numbness, heaviness, weakness or difficulty using arms or legs
- A band of pain around the chest or abdomen or pain down an arm or leg
- Changes in sensation, for example pins and needles or electric shock sensations
- Numbness in the area around the back passage (the saddle area)
- Not being able to empty the bowel or bladder
- Problems controlling the bowel or bladder
If you suspect that your patient may have MSCC it is important to act quickly in order to ensure the best outcome can be achieved.
- Admit: Admission to local A&E if patient is in the community
- Steroids: Commence 16 mg Dexamethasone OD (as initial loading dose) or 8 mg BD (unless contraindicated), with gastric protection
- Bed rest / log roll: To preserve spinal stability and help prevent neurological deterioration, patients should be nursed flat and log rolled until the MRI scan has been reported. Once spinal instability has been ruled out, careful remobilisation can begin
- Imaging: Perform and report an MRI of the whole spine within 24 hours if there is suspicion of MSCC. If there is a specific contraindication, a CT of the whole spine (with sagittal slices) should be completed
You can access the pathway flowchart [PDF, 248KB] and management guidance [PDF, 773KB] for more information.