Current Advancements in the Diagnosis and Treatment of Metastatic Spinal Cord Compression and Its Postintervention Care: A Comprehensive Review

TL;DR

This review discusses the latest developments in diagnosing and treating spinal cord compression caused by cancer, emphasizing early detection and multidisciplinary care.

Contribution

The paper provides a comprehensive review of current diagnostic and treatment strategies for metastatic spinal cord compression.

Findings

MRI with STIR sequences and the Bilsky grading system are key for accurate diagnosis.

Radiotherapy and surgery remain primary treatments, with robotic-assisted surgery and immunotherapy showing promise.

A multidisciplinary approach improves patient outcomes, including function recovery and quality of life.

Abstract

Malignant spinal cord compression (MSCC) is a serious oncological emergency that can result in neurological impairment and significant pain. It is associated with high morbidity, mortality, and a decrease in quality of life. This review reviews the current literature concerning diagnosis, guidelines, timely intervention, and management options in oncology patients with MSCC. A literature search of PubMed using relevant keywords and MeSH terms yielded 604 articles. Of these, 31 studies met the predefined inclusion criteria and were selected for detailed data extraction and synthesis into a narrative review.

MRI remains the gold standard for diagnosis, with newer systems like short tau inversion recovery (STIR) sequences being used, and includes the Bilsky grading system to improve classification and diagnosis for treatment. Radiotherapy and surgery continue to be the main treatment options. A multidisciplinary, personalized approach improves the amount of function recovered, pain control, and quality of life. New advances include robotic-assisted surgery and immunotherapy as future management options. Early recognition and clear, evidence-based guidelines are essential to reduce the morbidity and mortality of MSCC. This includes immediate administration of steroids, MRI imaging, and timely referral to appropriate departments, including acute oncology and neurosurgery. Additional research is needed to determine the main factors that impact patient recovery and quality of life.

Figures