Quality statement 2: Imaging and treatment plans for adults with suspected spinal metastases

Quality statement

Adults with spinal pain suggestive of spinal metastases, but with no neurological symptoms or signs, have an MRI of the whole spine and any necessary treatment plan agreed within 1 week of the suspected diagnosis.

Rationale

Adults with spinal pain suggestive of spinal metastases need timely access to imaging that will accurately identify spinal metastases. Whole-spine MRI is central to the diagnosis, staging and planning of treatment. If spinal metastases are suspected, it is essential that investigation, planning and treatment take place before any loss of neurological function occurs. To reduce the risk of avoidable disability for adults with suspected spinal metastases, it is important that an MRI is performed and that treatment is planned by senior clinical advisers, within 1 week of the suspected diagnosis.

Quality measures

Structure

Evidence of local arrangements and written protocols to ensure that adults with spinal pain suggestive of spinal metastases, but with no neurological symptoms or signs, have an MRI of the whole spine and any necessary treatment plan agreed within 1 week of the suspected diagnosis.

Data source: Local data collection.

Process

a) Proportion of adults with spinal pain suggestive of spinal metastases, but with no neurological symptoms or signs, who receive an MRI of the whole spine within 1 week of the suspected diagnosis.

Numerator – the number of adults in the denominator who receive an MRI of the whole spine within 1 week of presenting with spinal pain suggestive of spinal metastases, but with no neurological symptoms or signs.

Denominator – the number of adults who present with spinal pain suggestive of spinal metastases, but with no neurological symptoms or signs.

b) Proportion of adults with spinal metastases confirmed by MRI of the whole spine, but with no neurological symptoms or signs, who have a treatment plan agreed within 1 week of the suspected diagnosis.

Numerator – the number of adults in the denominator who have a treatment plan agreed within 1 week of presenting with spinal pain suggestive of spinal metastases, but with no neurological symptoms or signs.

Denominator – the number of adults with spinal metastases confirmed by MRI of the whole spine, but with no neurological symptoms or signs.

Data source: Local data collection. British Spine Registry Spinal tumour data (2013).

Outcome

a) Proportion of adults with spinal metastases who are able to walk within 3 months of treatment.

b) Proportion of adults with spinal metastases who are able to walk within 2 years of treatment.

c) Rates of mortality within 30 days of treatment.

Data source: Local data collection. British Spine Registry Spinal tumour data (2013).

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers ensure that adequate capacity is available for whole-spine MRI scanning and treatment planning to be undertaken within 1 week for adults with suspected spinal metastases who present with spinal pain but with no neurological symptoms or signs.

Healthcare professionals ensure that they perform an MRI of the whole spine for adults with suspected spinal metastases who present with spinal pain but with no neurological symptoms or signs, and agree any necessary treatment plan within 1 week of the suspected diagnosis.

Commissioners ensure that they commission services that can provide MRI scanning and treatment planning by senior clinical advisers within 1 week of the suspected diagnosis of spinal metastases for adults who have spinal pain but no neurological symptoms or signs.

What the quality statement means for patients, service users and carers

Adults with suspected spinal metastases (who have spinal pain only) have an MRI of their whole spine and, if necessary, have a plan for their treatment organised within 1 week of the suspected diagnosis.

Source guidance

  • Metastatic spinal cord compression (NICE clinical guideline 75), recommendation 1.4.3.3 (key priority for implementation).

Definitions of terms used in this quality statement

Symptoms of spinal metastases

The following symptoms are suggestive of spinal metastases:

  • progressive pain in the spine

  • severe unremitting spinal pain

  • localised spinal tenderness

  • nocturnal spinal pain preventing sleep.

[Definition developed from NICE clinical guideline 75 recommendation 1.3.2.1 and expert consensus]

Senior clinical advisers

Includes clinical oncologists, spinal surgeons and radiologists with experience and expertise in treating adults with spinal metastases. [Adapted from NICE clinical guideline 75 recommendation 1.1.2.4]

Treatment plan

A treatment plan for adults with spinal metastases should be agreed by senior clinical advisers, and the names of those involved in the discussion should be included in the documentation. Treatment planning should take account of:

  • spinal stability, which should be assessed both clinically and radiologically

  • the degree of neurological disability

  • the general health of the patient

  • the prognosis, which should be estimated using a validated scoring system

  • the primary site of tumour

  • the presence of other spinal and extraspinal metastases

  • the likely response of the tumour to radiotherapy or other adjuvant therapy

  • the patient's care and treatment preferences.

[The full clinical guideline 75, section 6.1 and expert consensus]