4 Research recommendations

The Guideline Development Group has made the following recommendations for research, based on its review of evidence, to improve NICE guidance and patient care in the future. The Guideline Development Group's full set of research recommendations is detailed in the full guideline (see section 5).

4.1 Reasons for delayed presentation

Further research should be undertaken into the reasons why patients with MSCC present late.

Although it is clear from the existing evidence that many patients with MSCC present late, often with established and irreversible neurological problems or a long preceding history of symptoms, the reasons for this are not understood.

4.2 Use of radiotherapy in the prevention of MSCC

The use of radiotherapy to prevent the development of MSCC in patients with identified spinal metastases but no pain should be investigated in prospective randomised controlled trials.

There is currently no reliable evidence to indicate whether the use of prophylactic radiotherapy can prevent the development of MSCC in patients with known metastases in the spine but no pain.

4.3 Use of surgery in the prevention of MSCC

The use of surgery to prevent the development of MSCC in patients with identified spinal metastases but no pain should be investigated in prospective randomised controlled trials.

There is currently no reliable evidence to indicate whether the use of prophylactic surgery can prevent the development of MSCC in patients with known metastases in the spine but no pain.

4.4 Management of MSCC

Further research should investigate what are the most clinically and cost-effective regimens of radiotherapy to treat patients with established MSCC and investigate the use of new techniques, such as intensity-modulated radiation therapy.

Currently there is insufficient high-quality evidence of effect of different regimens of radiotherapy to treat patients with established MSCC. In order to evaluate the effects of different regimens of radiotherapy, more randomised controlled trials are required. There is no evidence that evaluates new techniques, such as intensity-modulated radiation therapy, in patients with MSCC.

4.5 Use of vertebroplasty and kyphoplasty in preventing MSCC

The use of vertebroplasty and kyphoplasty in preventing MSCC in patients with vertebral metastases should be investigated in prospective, comparative studies.

These procedures have been investigated in observational studies without comparators and largely in patients with osteoporotic vertebral collapse. There is limited evidence about their use in patients with MSCC.

  • National Institute for Health and Care Excellence (NICE)