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    Metastatic spinal cord compression (update)

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    3 What the guideline will cover

    3.1 Groups that will be covered

    3.1.1 Adults with suspected or confirmed metastatic spinal disease and suspected or confirmed direct malignant infiltration of the spine.

    3.1.2 Adults with suspected or confirmed spinal cord or nerve root compression because of metastatic spinal disease or direct malignant infiltration of the spine.

    3.2 Groups that will not be covered

    3.2.1 Adults with spinal cord compression because of primary tumours of the spinal cord, meninges or nerve roots.

    3.2.2 Adults with spinal cord compression because of non-malignant causes.

    3.2.3 Adults with primary bone tumours of the spinal column.

    3.2.4 Children and young people under the age of 18.

    3.3 Settings that will be covered

    3.3.1 All settings where NHS commissioned care is provided.

    3.4 Key areas that will be covered

    We will look at evidence in the areas below when developing the guideline, but it may not be possible to make recommendations in all the areas.

    3.4.1 Information and support

    3.4.2 Service configuration and delivery

    • configuration of services and delivery arrangements for investigations and referral

    • configuration of services and delivery arrangements for management

    3.4.3 Recognition

    • symptoms and signs of spinal metastatic malignant disease or direct malignant infiltration of the spine

    • symptoms and signs of spinal cord compression

    3.4.4 Investigations

    • radiological imaging techniques in diagnosis

    • radiological imaging techniques to guide management

    3.4.5 Prognostic tools

    • scoring systems to determine spinal instability

    • scoring systems to determine survival

    3.4.6 Treatment

    • pain management

    • techniques or methods of immobilisation

    • bisphosphonate agents

    • radiotherapy (both fractionated and unfractionated)

    • invasive interventions such as vertebroplasty, kyphoplasty, ablation and surgery

    • corticosteroid therapy

    3.5 Areas that will not be covered

    3.5.1 Rehabilitation after treatment for spinal cord compression

    3.5.2 Systemic oncological treatment

    3.6 Related NICE guidance

    3.7 Related NICE guidance in development

    3.8 NICE guidance that will be updated by this guideline

    3.9 NICE guidance about the experience of people using NHS services

    NICE has produced the following guidance on the experience of people using the NHS. This guideline will not include additional recommendations on these topics unless there are specific issues related to metastatic spinal cord compression:

    3.10 Economic aspects

    We will take economic aspects into account when making recommendations. We will develop an economic plan that states for each review question (or key area in the scope) whether economic considerations are relevant, and if so whether this is an area that should be prioritised for economic modelling and analysis. We will review the economic evidence and carry out economic analyses, using an NHS and personal social services (PSS) perspective, as appropriate.