Do Not Do Recommendation

Do Not Do Recommendation Details

Recommendation:

Patients with spinal metastases without pain or instability should not be offered surgery with the intention of preventing metastatic spinal cord compression (MSCC) except as part of a randomised controlled trial.

Interventions:

surgery

Source guidance details

Guidance:

Metastatic spinal cord compression (CG75)

Published date:

November 2008

Paragraph number:

1.5.1.13

Page number:

19

View all NICE do not do from this Guidance

• Bisphosphonates should not be used to treat spinal pain in patients with vertebral involvement from tumour types other than myeloma, breast cancer or prostate cancer (if conventional analgesia fails) or with the intention of preventing metastatic spinal cord compression (MSCC), except as part of a randomised controlled trial.
• Patients with asymptomatic spinal metastases should not be offered radiotherapy with the intention of preventing metastatic spinal cord compression (MSCC) except as part of a randomised controlled trial.
• Posterior decompression alone should not be performed in patients with metastatic spinal cord compression (MSCC) except in the rare circumstances of isolated epidural tumour or neural arch metastases without bony instability.
• En bloc excisional surgery with the objective of curing the cancer should not be attempted, except in very rare circumstances (for example, confirmed solitary renal or thyroid metastasis following complete staging).
• Preoperative radiotherapy should not be carried out on patients with metastatic spinal cord compression (MSCC) if surgery is planned.
• Do not perform plain radiographs of the spine either to make or to exclude the diagnosis of spinal metastases or metastatic spinal cord compression (MSCC).
• In patients with a previous diagnosis of malignancy, routine imaging of the spine is not recommended if they are asymptomatic.