Metastatic spinal cord compression: a review of practice and care
Lynn Kilbride
Authors: Lynn Kilbride , PhD, MSc, PGCE, BSc, RGN, Senior Lecturer, School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh; Marie Cox , MSc, Research Fellow, School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh; Catriona M Kennedy , BA, PhD, Dip Nurs., RN, DN, RNT, DNT, PWT, Professor, School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh; Siew Hwa Lee , MPHe, BSc, Cert. Ed, RGN, RM Counselling, PhD Student, School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh; Robin Grant , MBChB, MD, FRCP (Glasgow), FRCP (Edinburgh), Consultant Neurologist, Edinburgh Centre for Neuro-Oncology, Western General Hospital
Search for more papers by this authorMarie Cox
Authors: Lynn Kilbride , PhD, MSc, PGCE, BSc, RGN, Senior Lecturer, School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh; Marie Cox , MSc, Research Fellow, School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh; Catriona M Kennedy , BA, PhD, Dip Nurs., RN, DN, RNT, DNT, PWT, Professor, School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh; Siew Hwa Lee , MPHe, BSc, Cert. Ed, RGN, RM Counselling, PhD Student, School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh; Robin Grant , MBChB, MD, FRCP (Glasgow), FRCP (Edinburgh), Consultant Neurologist, Edinburgh Centre for Neuro-Oncology, Western General Hospital
Search for more papers by this authorCatriona M Kennedy
Authors: Lynn Kilbride , PhD, MSc, PGCE, BSc, RGN, Senior Lecturer, School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh; Marie Cox , MSc, Research Fellow, School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh; Catriona M Kennedy , BA, PhD, Dip Nurs., RN, DN, RNT, DNT, PWT, Professor, School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh; Siew Hwa Lee , MPHe, BSc, Cert. Ed, RGN, RM Counselling, PhD Student, School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh; Robin Grant , MBChB, MD, FRCP (Glasgow), FRCP (Edinburgh), Consultant Neurologist, Edinburgh Centre for Neuro-Oncology, Western General Hospital
Search for more papers by this authorSiew Hwa Lee
Authors: Lynn Kilbride , PhD, MSc, PGCE, BSc, RGN, Senior Lecturer, School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh; Marie Cox , MSc, Research Fellow, School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh; Catriona M Kennedy , BA, PhD, Dip Nurs., RN, DN, RNT, DNT, PWT, Professor, School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh; Siew Hwa Lee , MPHe, BSc, Cert. Ed, RGN, RM Counselling, PhD Student, School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh; Robin Grant , MBChB, MD, FRCP (Glasgow), FRCP (Edinburgh), Consultant Neurologist, Edinburgh Centre for Neuro-Oncology, Western General Hospital
Search for more papers by this authorRobin Grant
Authors: Lynn Kilbride , PhD, MSc, PGCE, BSc, RGN, Senior Lecturer, School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh; Marie Cox , MSc, Research Fellow, School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh; Catriona M Kennedy , BA, PhD, Dip Nurs., RN, DN, RNT, DNT, PWT, Professor, School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh; Siew Hwa Lee , MPHe, BSc, Cert. Ed, RGN, RM Counselling, PhD Student, School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh; Robin Grant , MBChB, MD, FRCP (Glasgow), FRCP (Edinburgh), Consultant Neurologist, Edinburgh Centre for Neuro-Oncology, Western General Hospital
Search for more papers by this authorLynn Kilbride
Authors: Lynn Kilbride , PhD, MSc, PGCE, BSc, RGN, Senior Lecturer, School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh; Marie Cox , MSc, Research Fellow, School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh; Catriona M Kennedy , BA, PhD, Dip Nurs., RN, DN, RNT, DNT, PWT, Professor, School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh; Siew Hwa Lee , MPHe, BSc, Cert. Ed, RGN, RM Counselling, PhD Student, School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh; Robin Grant , MBChB, MD, FRCP (Glasgow), FRCP (Edinburgh), Consultant Neurologist, Edinburgh Centre for Neuro-Oncology, Western General Hospital
Search for more papers by this authorMarie Cox
Authors: Lynn Kilbride , PhD, MSc, PGCE, BSc, RGN, Senior Lecturer, School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh; Marie Cox , MSc, Research Fellow, School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh; Catriona M Kennedy , BA, PhD, Dip Nurs., RN, DN, RNT, DNT, PWT, Professor, School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh; Siew Hwa Lee , MPHe, BSc, Cert. Ed, RGN, RM Counselling, PhD Student, School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh; Robin Grant , MBChB, MD, FRCP (Glasgow), FRCP (Edinburgh), Consultant Neurologist, Edinburgh Centre for Neuro-Oncology, Western General Hospital
Search for more papers by this authorCatriona M Kennedy
Authors: Lynn Kilbride , PhD, MSc, PGCE, BSc, RGN, Senior Lecturer, School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh; Marie Cox , MSc, Research Fellow, School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh; Catriona M Kennedy , BA, PhD, Dip Nurs., RN, DN, RNT, DNT, PWT, Professor, School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh; Siew Hwa Lee , MPHe, BSc, Cert. Ed, RGN, RM Counselling, PhD Student, School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh; Robin Grant , MBChB, MD, FRCP (Glasgow), FRCP (Edinburgh), Consultant Neurologist, Edinburgh Centre for Neuro-Oncology, Western General Hospital
Search for more papers by this authorSiew Hwa Lee
Authors: Lynn Kilbride , PhD, MSc, PGCE, BSc, RGN, Senior Lecturer, School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh; Marie Cox , MSc, Research Fellow, School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh; Catriona M Kennedy , BA, PhD, Dip Nurs., RN, DN, RNT, DNT, PWT, Professor, School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh; Siew Hwa Lee , MPHe, BSc, Cert. Ed, RGN, RM Counselling, PhD Student, School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh; Robin Grant , MBChB, MD, FRCP (Glasgow), FRCP (Edinburgh), Consultant Neurologist, Edinburgh Centre for Neuro-Oncology, Western General Hospital
Search for more papers by this authorRobin Grant
Authors: Lynn Kilbride , PhD, MSc, PGCE, BSc, RGN, Senior Lecturer, School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh; Marie Cox , MSc, Research Fellow, School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh; Catriona M Kennedy , BA, PhD, Dip Nurs., RN, DN, RNT, DNT, PWT, Professor, School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh; Siew Hwa Lee , MPHe, BSc, Cert. Ed, RGN, RM Counselling, PhD Student, School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh; Robin Grant , MBChB, MD, FRCP (Glasgow), FRCP (Edinburgh), Consultant Neurologist, Edinburgh Centre for Neuro-Oncology, Western General Hospital
Search for more papers by this authorAbstract
Aim and objectives. The aim of this review was to address: (1) How is spinal stability assessed? (2) What is the role of bracing/should braces be used? (3) When is it safe to mobilise the patient? (4) What position should the patient be nursed in?
Background. Controversy surrounds the care for patients with metastatic spinal cord compression (MSCC). There is some evidence to indicate that care for patients with MSCC is based on individual clinician preference rather than evidence-based guidelines which has been shown to cause delays and discrepancies in patient treatment.
Design. A structured literature review to synthesise the available evidence about the management of MSCC.
Methods. The following databases were searched: Medline, EMBASE, Cochrane Systematic Reviews Database, SIGN (Scottish Intercollegiate Guidelines Network), NICE (National Institute for Clinical Excellence), AMED (Allied and Complementary Medicine), CINAHL (Cumulative Index to Nursing and Allied Health Literature) and BNI (British Nursing Index). Publications were selected from the past 10 years. The search yielded a total of 1057 hits, 755 abstracts were screened, and 73 articles were retrieved and examined. Thirty-five articles were included.
Results. The findings identified a gap and evidence relating to spinal stability, bracing, patient mobilisation, and positioning is limited and may be inconclusive. It is important for patients with a poor prognosis that their preferences and quality of life are considered.
Conclusion. Currently, the evidence base to underpin care is limited, and further research in this area is necessary for patients and healthcare professionals alike.
Relevance to clinical practice. Patients who suffer from MSCC suffer numerous physical, psychological and social issues. Because of lack of consensus, the current guidelines to inform clinical decision-making of professional staff are of limited benefit.
References
- Aass N & Fossa SD (2005) Pre- and post-treatment daily life function in patients with hormone resistant prostate carcinoma treated with radiotherapy for spinal cord compression. Radiotherapy and Oncology 74, 259–265.
- Abrahm JL (2004) Assessment and treatment of patients with malignant spinal cord compression. Journal of Supportive Oncology 2, 377–401.
- Abrahm JL, Banffy MB & Harris MB (2008) Spinal cord compression in patients with advanced metastatic cancer: ‘all I care about is walking and living my life’. JAMA 299, 937–946.
- Aebi M (2003) Spinal metastasis in the elderly. European Spine Journal 12(Suppl. 2), S202–S213.
- Barton MB, Dawson R, Jacob S, Currow D, Stevens G & Morgan G (2001) Palliative radiotherapy of bone metastases: an evaluation of outcome measures. Journal of Evaluation in Clinical Practice 7, 47–64.
-
Bilsky MH &
Azeem S (2007) The NOMS framework for decision making in metastatic cervical spine tumors.
Current Opinion in Orthopaedics
18, 263–269.
10.1097/BCO.0b013e3280d942fc Google Scholar
- Bilsky M & Smith M (2006) Surgical approach to epidural spinal cord compression. Hematology - Oncology Clinics of North America 20, 1307–1317.
- Bilsky MH, Lis E, Raizer J, Lee H & Boland P (1999) The diagnosis and treatment of metastatic spinal tumor. The Oncologist 4, 459–469.
- Borm W, Gleixner M & Klasen J (2004) Spinal tumors in coexisting degenerative spine disease–a differential diagnostic problem. European Spine Journal 13, 633–638.
- Byrne TN (1992) Spinal cord compression from epidural metastases. New England Journal of Medicine 327, 614–619.
- Byrne MD, Borges L & Loeffler JS (2006) Metastatic epidural spinal cord compression: update on management. Seminars in Oncology 33, 307–311.
- Coleman RE (2006) Clinical features of metastatic bone disease and risk of skeletal morbidity. Clinical Cancer Research 12(20 Pt 2), 6243s–6249s.
- Cybulski GR (1989) Methods of surgical stabilization for metastatic disease of the spine. Neurosurgery 25, 240–252.
- Dirksmeier PJ & Kang JD (2001) Instability of the spine as a result of metastatic disease. Seminars in Spine Surgery 13, 57–64.
- Eriks IE, Angenot EL & Lankhorst GJ (2004) Epidural metastatic spinal cord compression: functional outcome and survival after inpatient rehabilitation. Spinal Cord 42, 235–239.
- Eva G & Lord S (2003) Rehabilitation in malignant spinal cord compression. European Journal of Palliative Care 10, 148–150.
-
Fourney DR &
Gokaslan ZL (2003) Spinal instability and deformity due to neoplastic conditions.
Neurosurg Focus
14, 1–7 (article 8).
10.3171/foc.2003.14.1.9 Google Scholar
- Fourney DR, York JE, Cohen ZR, Suki D, Rhines LD & Gokaslan ZL (2003) Management of atlantoaxial metastases with posterior occipitocervical stabilization. Journal of Neurosurgery 98(Suppl. 2), 165–170.
- Galasko CSB, Norris HE & Crank S (2000) Spinal instability secondary to metastatic cancer. The Journal of Bone and Joint Surgery (American) 82A, 570–576.
- Gilbert RW, Kim JH & Posner JB (1978) Epidural spinal cord compression from metastatic tumor: diagnosis and treatment. Annals of Neurology 3, 40–51.
- Godersky JC, Smoker WRK & Knutzon R (1987) Use of magnetic resonance imaging in the evaluation of metastatic spinal disease. Neurosurgery 21, 676–680.
- Gupta V, Khandelwal N, Mathuria SN, Singh P, Pathak A & Suri S (2007) Dynamic magnetic resonance imaging evaluation of craniovertebral junction abnormalities. Journal of Computer Assisted Tomography 31, 354–359.
- Gurusinghe NT (1997) Spinal tumors. In Spinal Cord Disease: Basic Science, Diagnosis and Management ( E Critchly & A Eisen eds). Springer, London, pp. 501–544.
- Hatrick NC, Lucas JD, Timothy AR & Smith MA (2000) The surgical treatment of metastatic disease of the spine. Radiotherapy and Oncology 56, 335–339.
- Heary RF & Bono CM (2001) Metastatic spinal tumors. Neurosurgery Focus 11, 1–9.
- Held JL & Peahota A (1993) Nursing care of the patient with spinal cord compression. Oncology Nursing Forum 20, 189–191.
- Husband DJ, Grant KA & Romaniuk CS (2001) MRI in the diagnosis and treatment of suspected malignant spinal cord compression. The British Journal of Radiology 74, 15–23.
- Jacobs P (1999) Malignant spinal cord compression. Palliative Care Today 8, 20–21.
- Jacobs WB & Perrin RG (2001) Evaluation and treatment of spinal metastases: an overview. Neurosurg Focus 11, e10.
- Jenis LG, Dunn EJ & Howard S (1999) Metastatic disease of the cervical spine. A review. Clinical Orthopaedics and Related Research 359, 89–103.
- Khaw FM, Worthy SA, Gibson MJ & Gholkar A (1999) The appearnce on MRI of vertebrae in acute compression of the spinal cord due to metastases. Journal of Bone and Joint Surgery (Br) 81, 830–834.
- Klimo PJ, Kestle J & Schmidt MH (2004) Clinical trials and evidence-based medicine for metastatic spine disease. Neurosurgery Clinics of North America 15, 549–564.
- Kostuik J & Weinstein J (1991) Differential Diagnosis and Surgical Treatment of Metastatic Spine Tumors. Raven Press, New York.
- Levack P, Garham J, Collie D, Grant R, Kidd J, Kunkler I, Gibson A, Hurman D, McMillan N, Rampling R, Slider L, Statham P, Summers D & the Scottish Cord Compression Study Group (2002) Don’t wait for a sensory level-listen to the symptoms: a prospective audit of the delays in diagnosis of malignant cord compression. Clinical Oncology 14, 472–480.
- Loblaw DA & Laperriere NJ (1998) Emergency treatment of malignant extradural spinal cord compression: an evidence-based guideline. Journal of Clinical Oncology 16, 1613–1624.
- Loblaw DA, Perry J, Chambers A & Laperriere NJ (2005) Systematic review of the diagnosis and management of malignant extradural spinal cord compression: the Cancer Care Ontario Practice Guidelines Initiative’s Neuro-Oncology Disease Site Group. [see comment]. Journal of Clinical Oncology 23, 2028–2037.
- Maher de Leon ME, Schnell S & Rozental JM (1998) Tumours of the spine and spinal cord. Seminars in Oncology Nursing 14, 43–52.
- McClinton A & Hutchison C (2006) Malignant spinal cord compression, a retrospective audit of clinical practive at the beatson oncology centre. British Journal of Cancer 94, 486–491.
- McKinley WO, Huang ME & Tewksbury MA (2000) Neoplastic vs. traumatic spinal cord injury: an inpatient rehabilitation comparison. American Journal of Physical Medicine & Rehabilitation 79, 138–144.
- Mercadante S (1997) Malignant bone pain: pathophysiology and treatment. Pain 69, 1–18.
- National Institute for Health and Clinical Excellence (2008) Metastatic Spinal Cord Compression, Diagnosis and Management of adults at risk of and with MSCC.Guideline 75, National Collboarting Centre for Cancer.
- North RB, LaRocca VR, Schwartz J, North CA, Zahurak M, Davis RF & McAfee PC (2005) Surgical management of spinal metastases: analysis of prognostic factors during a 10-year experience. Journal of Neurosurg Spine 2, 564–573.
- Obbens EA & Posner JB (1987) Systemic cancer involving the spinal cord. In Handbook of the Spinal Cord ( RA Davidoff ed). Marcel Dekker, New York, pp. 451–489.
- Parsch D, Mikut R & Abel R (2003) Postacute management of patients with spinal cord injury due to metastatic tumour disease: survival and efficacy of rehabilitation. Spinal Cord 41, 205–210.
- Patchell RA, Tibbs PA, Regine WF, Payne R, Saris S, Kryscio RJ, Mohiuddin M & Young B (2005) Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. The Lancet 366, 643–648.
-
Pease NJ,
Harris RJ &
Finlay IG (2004) Development and audit of a care pathway for the management of patients with suspected malignant spinal cord compression.
Physiotherapy
90, 27–34.
10.1016/S0031-9406(03)00006-3 Google Scholar
-
Pilitsis JG &
Rengachary SS (2001) The role of vertebroplasty in metastatic spinal disease.
Neurosurgery Focus
11, 1–9.
10.3171/foc.2001.11.6.10 Google Scholar
- Posner JB (1995) Neurologic complications of cancer. In Contemporary Neurology Series, Vol. 45 ( RW Reinhardt, Wissler BM & Massey R eds). FA Davis, Philadelphia, PA, pp. 1–5.
- Poste G & Fidler IJ (1980) The pathogenesis of cancer metastasis. Nature 283, 139–146.
- Schiff D (2003) Spinal cord compression. Neurologic Clinics 21, 67–86.
- Shimada Y, Miyakoshi N, Kasukawa Y, Hongo M, Ando S & Itoi E (2006) Clinical Features of Cauda Equina Tumors Requiring Surgical Treatment. Tohoku Journal of Experimental Medicine 209, 1–6.
- Siegal T & Siegal T (1989) Current considerations in the management of neoplastic spinal cord compression. Spine 14, 223–228.
- Stubblefield MD & Bilsky MH (2007) Barriers to rehabilitation of the neurosurgical spine cancer patient. Journal of Surgical Oncology 95, 419–426.
- Sundaresan N, Galicich JH, Lane JM & Greenberg HS (1981) Treatment of odontoid fractures in cancer patients. Journal of Neurosurgery 54, 187–192.
- Sundaresan N, Sachdev VP, Holland JF, Moore F, Sung M, Paciucci PA, Wu LT, Kelligher K & Hough L (1995) Surgical treatment of spinal cord compression from epidural metastasis. Journal of Clinical Oncology 13, 2330–2335.
- Tang V, Harvey D, Park Dorsay J, Jiang S & Rathbone MP (2007) Prognostic indicators in metastatic spinal cord compression: using functional independence measure and Tokuhashi scale to optimize rehabilitation planning. Spinal Cord 45, 671–677.
-
Villavicencio A,
Oskouian RJ,
Roberson C,
Stokes J
et al.
(2005) Thoracolumbar vertebral reconstruction after surgery for metastatic spinal tumors: long-term outcomes.
Neurosurgery Focus
19, 1–8.
10.3171/foc.2005.19.3.9 Google Scholar
- White AA & Panjabi MM (1978) Clinical Biomechanics of the Spine. JB Lippincott Company, Philadelphia, PA.
- White AA & Panjabi MM (1990) Clinical Biomechanics of the Spine, 2nd edn. JB Lippincott Company, Philadelphia, PA.
- Wise JJ, Fischgrund JS, Herkowitz HN, Montgomery D & Kurz LT (1999) Complication, survival rates and risk factors of surgery for metastatic disease of the spine. Spine 24, 1943–1951.
- Zimmerman M, Wolff R, Raabe A, Stolke D & Seifert V (2002) Palliative occipito-cervical stabilization in paitents with malignant tumors of the occipito-cervical junction and the upper cervical spine. Acta Neurocir 144, 783–790.
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