Quality standard

Quality statement 3: Imaging for adults with suspected metastatic spinal cord compression

Quality statement 3: Imaging for adults with suspected metastatic spinal cord compression

Quality statement

Adults with suspected metastatic spinal cord compression (MSCC) who present with neurological symptoms or signs have an MRI of the whole spine within 24 hours of the suspected diagnosis.

Rationale

Adults with suspected MSCC who present with neurological symptoms or signs need rapid access to imaging that will accurately identify spinal cord compression. MRI of the whole spine is central to the diagnosis, staging and planning of treatment. Neurological deficit at initial presentation is an important predictor of long-term functional outcome. To reduce the risk of avoidable disability for adults with suspected MSCC, it is important that an MRI of the whole spine is performed within 24 hours of the suspected diagnosis.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Process

Proportion of adults with suspected MSCC who present with neurological symptoms or signs who receive an MRI of the whole spine within 24 hours of the suspected diagnosis.

Numerator – the number of adults in the denominator who receive an MRI of the whole spine within 24 hours of presenting with suspected MSCC and neurological symptoms or signs.

Denominator – the number of adults with suspected MSCC who present with neurological symptoms or signs.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

What the quality statement means for different audiences

Service providers ensure that adequate capacity is available for whole-spine MRI scanning to be undertaken within 24 hours for adults with suspected MSCC who present with neurological symptoms or signs.

Healthcare professionals ensure that they perform an MRI of the whole spine for adults with suspected MSCC who present with neurological symptoms or signs.

Commissioners ensure that they commission services that can provide MRI scanning within 24 hours of the suspected diagnosis for adults with suspected MSCC who present with neurological symptoms or signs.

Adults with suspected MSCC have an MRI of their whole spine within 24 hours of the suspected diagnosis.

Source guidance

Spinal metastases and metastatic spinal cord compression. NICE guideline NG234 (2023), recommendations 1.1.19, 1.5.2, 1.5.5 and box 1.

Definitions of terms used in this quality statement

Symptoms or signs suggestive of MSCC

The following pain characteristics are suggestive of spinal metastases:

  • severe unremitting back pain

  • progressive back pain

  • mechanical pain (aggravated by standing, sitting or moving)

  • back pain aggravated by straining (for example, coughing, sneezing or bowel movements)

  • night-time back pain disturbing sleep

  • localised tenderness

  • claudication (muscle pain or cramping in the legs when walking or exercising).

The following pain characteristics are suggestive of cord compression:

  • bladder or bowel dysfunction

  • gait disturbance or difficulty walking

  • limb weakness

  • neurological signs of spinal cord or cauda equina compression

  • numbness, paraesthesia or sensory loss

  • radicular pain.

[Adapted from NICE's guideline on spinal metastases and metastatic spinal cord compression, box 1]