Metastatic spinal cord compression (MSCC) is defined in this guideline as spinal cord or cauda equina compression by direct pressure and/or induction of vertebral collapse or instability by metastatic spread or direct extension of malignancy that threatens or causes neurological disability. The true incidence of MSCC in England and Wales is unknown because cases are not systematically recorded. However, evidence from an audit carried out in Scotland between 1997 and 1999 and from a published study from Canada, suggests that the incidence may be up to 80 cases per million people every year. This equates to approximately 4000 cases each year in England and Wales, or more than 100 cases per cancer network each year.
The Scottish audit showed that there were significant delays from the time when patients first develop symptoms to when general practitioners and hospital doctors recognise the possibility of MSCC and make an appropriate referral. The median times from the onset of back pain and nerve root pain to referral were 3 months and 9 weeks, respectively. Nearly half of all patients with MSCC were unable to walk at the time of diagnosis and of these, the majority (67%) had recovered no function after 1 month. Of those who could walk unaided at the time of diagnosis, 81% were able to walk (either alone or with aid) at 1 month. The ability to walk at diagnosis was also significantly related to overall survival.
At present, relatively few patients with MSCC in the UK receive surgery for the condition. However, research evidence suggests that early surgery may be more effective than radiotherapy at maintaining mobility in a selected subset of patients.
The guideline will assume that prescribers will use a drug's summary of product characteristics to inform their decisions for individual patients.
 Levack P et al (2001) A prospective audit of the diagnosis, management and outcome of malignant cord compression (CRAG 97/08). Edinburgh: CRAG.
 Loblaw DA, Laperriere NJ, Mackillop WJ (2003) A population-based study of malignant spinal cord compression in Ontario. Clinical Oncology 15 (4): 211–17.