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National Collaborating Centre for Cancer (UK). Metastatic Spinal Cord Compression: Diagnosis and Management of Patients at Risk of or with Metastatic Spinal Cord Compression. Cardiff (UK): National Collaborating Centre for Cancer (UK); 2008 Nov. (NICE Clinical Guidelines, No. 75.)

Cover of Metastatic Spinal Cord Compression

Metastatic Spinal Cord Compression: Diagnosis and Management of Patients at Risk of or with Metastatic Spinal Cord Compression.

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Appendix 8List of topics covered by each chapter

Chapter 2 – Service configuration and urgency of treatment

  • What is the most effective way of delivering care and coordinating services for patients with MSCC or suspected MSCC?

Chapter 3 – The patient’s experience of MSCC

  • How effective are decision aids for patients with MSCC facing treatment decisions?
  • What is the most effective emotional and family support interventions for patients with MSCC?
  • In patients with MSCC, what effect does delay from presentation to definitive treatment have on clinical outcomes (mobility, urinary continence, lack of pain, survival independent living)?
  • In patients with MSCC, what effect does performance status at the time of treatment have on clinical outcomes (mobility, urinary continence, lack of pain, survival independent living)?
  • In patients with a clinical diagnosis of malignant spinal cord compression, how soon should definitive treatment be undertaken to prevent permanent neurological deficit?

Chapter 4 – Early detection

  • What is the most effective way to communicate the risks of MSCC to patients with primary carcinoma [to your patient]?
  • What is the most effective way to communicate the symptoms of MSCC to patients with primary carcinoma [to your patient]?
  • In patients with cancer at risk of developing spinal cord compression, what symptoms and signs give early indications that malignant SCC is developing?
  • In patients with suspected bone metastases in the spine, does MRI (or CT?) scanning (compared to not scanning) identify patients at risk of developing MSCC and improve clinical outcomes (prevention of established MSCC, mobility, cost)
  • In patients with known bone metastases in the spine, does serial imaging identify patients at risk of developing MSCC improve clinical outcomes (prevention of established MSCC, improve mobility, cost)

Chapter 5 – Imaging

  • What is the best imaging modality for diagnosis of spinal cord compression?

Chapter 6 – Treatment of spinal metastases and MSCC

  • Is epidural/spinal/intrathecal anaesthesia a safe and effective intervention in suspected/ confirmed MSCC?
  • What is the effectiveness of Bisphosphonates at treating spinal pain and/or preventing spinal collapse and/or spinal cord compression?
  • What is the effectiveness of RT at treating spinal pain and/or preventing spinal collapse and/or spinal cord compression?
  • What is the effectiveness of Vertebroplasty/Kyphoplasty at treating spinal pain and/or preventing spinal collapse and/or spinal cord compression?
  • What is the effectiveness of Stabilisation surgery to prevent vertebral collapse, (where Stabilisation surgery is +/– Intra-lesional debulking to prevent cord compromise)?
  • For patients with known MSCC who have had surgery/RT/no treatment does ‘early’ mobilisation give better outcomes (mobility, pain) than ‘delayed’ (needs definition).
  • For patients with suspected/confirmed MSCC, what is the most effective steroid regimen wrt preserving or improving mobility; neurology; duration of effect and toxicity?
  • Case selection for treatment — What is the validity of Tomita and Tokuhashi scoring systems?
  • Case selection for surgery — For patients with an established diagnosis of MSCC, what factors predict for successful outcomes (mobility, continence, lack of pain, survival) following surgery?
  • Case selection for radiotherapy — For patients with an established diagnosis of MSCC, what factors predict for successful outcomes (mobility, continence, lack of pain, survival) following RT?
  • What surgical technique is the most effective in treating patients with known MSCC in terms of outcomes outlined below?
  • In patients with known MSCC referred for radiotherapy, what is the most effective and cost effective dose fractionation regimen?

Chapter 7 – Supportive care and rehabilitation

  • What is the most effective bladder and bowel management for patients with spinal cord injury (MSCC)
  • What is the most effective thrombo-prophylactic management for patients with spinal cord injury (MSCC)
  • What is the most effective pressure ulcer management for patients with spinal cord injury (MSCC)
  • What is the most effective respiratory and circulatory management for patients with spinal cord injury (MSCC)
  • Given that specialised centres for patients with spinal injuries (or specialised wards for neuro-patients) exist and provide services that benefit patients; can MSCC patients also benefit from these kinds of services (wards/centres)?
  • Which MSCC patient factors will predict for beneficial outcomes from specialised services?
Copyright © 2008, National Collaborating Centre for Cancer.

No part of this publication may be reproduced, stored or transmitted in any form or by any means, without the prior written permission of the publisher or, in the case of reprographic reproduction, in accordance with the terms of licenses issued by the Copyright Licensing Agency in the UK. Enquiries concerning reproduction outside the terms stated here should be sent to the publisher at the UK address printed on this page.

The use of registered names, trademarks etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant laws and regulations and therefore for general use.

Bookshelf ID: NBK55003
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