Back to TAM (Treatments and Medicines) NHS Highland home NHS Highland

Malignant spinal cord compression (Guidelines)



  • Highland HSCP
  • Primary and Secondary Care.
  • Adults only 

What is malignant spinal cord compression (MSCC)

A MSCC is an oncological emergency that occurs when the dural sac and its content are compressed at the level of the spinal cord or cauda equina.  They can result from direct pressure, vertebral collapse or instability caused by metastatic spread or by direct extension of a malignancy.  

MSCC affects 5 to 10% of patients with a diagnosis of cancer but can also be the first presentation of malignancy.  MSCC should be considered in malignancy especially if there is bone involvement.  

Late diagnosis due to delays in recognition can result in significant pain, permanent loss of function and significant morbidity.  

The MSCC Pathway at NHS Highland

Early recognition of a MSCC may prevent or limit irreversible neurological damage.  

If you suspect a patient has symptoms of a MSCC then contact the MSCC coordinator urgently, ideally within 24hrs of symptom development. 

Could this be a MSCC

Does the patient have:

  • a history of cancer and/or suspicion of metastatic cancer 
  • new onset back pain 
  • new difficulty walking 

Do not discount the MSCC pathway if there are only 2 indicators.  

Warning signs of MSCC

Early signs 

  • new onset difficulty walking 
  • use of walking aids 
  • unexplained dalls 
  • lack of proprioception 
  • intermittent weakness that is unilateral or/bilateral 
  • sever pain in neck or back - radicular in nature 
  • new progressive intractable pain often described as band link pain around chest and down legs 

Late signs

  • sensory disturbance 
  • bladder/bowel disturbance 
  • paralysis 

Contacting the MSCC Coordinator

Contacting your local MSCC Coordinator will ensure rapid assessment, investigation and treatment of a patient with suspicion of a MSCC.

At NHS Highland, therapeutic radiographers within the radiotherapy department at Raigmore Hospital are the MSCC coordinators.  They are supported by the on-call Oncologist.  


In hours: 

  • Monday - Friday 9am - 5pm
  • MSCC Coordinator via bleep 2134 or
  • Raigmore switchboard (01463 704000) ask for the malignant or metastatic spinal cord coordinator 

Out of Hours 

  • On-call oncologist via Raigmore switchboard 01463 704000 

The MSCC Coordinator will: 

  • act as a single point of contact for the triage and discussion of patient symptoms
  • seek advice from the on-call oncologist on a patients eligibility for the MSCC pathway 
  • If a patient is eligible for the pathway, they will organise a MRI scan and ward admission if applicable.  



  • administer 16mg Dexamethasone daily unless contraindicated 
  • consider gastro-protective cover if patient is high risk 

If MRI scan negative: 

  • stop any additionally prescribed Dexamethasone 

If MRI scan positive: 

  • continue on Dexamethasone 16mg once daily until treatment is completed.  
  • Then follow a stepwise reduction of Dexamethasone reducing to a minimum as soon as possible as guided by clinical condition of the patient.  

Analgesia administered as required


  • Radiotherapy is the most common treatment option for patients with MSCC. If the patient is positive for MSCC then the on-call oncologist will make the decision on whether they will receive urgent radiotherapy.  

Moving and handling care

If mobile at presentation: 

  • Local agreement in NHS Highland is to keep a mobile patient mobile.
  • Advise not to carry anything
  • Seek assistance on transfer and climbing stairs
  • Refrain from driving.

If severe pain on movement 

  • may indicate spinal instability
  • consider advising patient to lie flat until assessment/MRI has been made and log roll 


  • Where paralysis is observed, patients remain on bed rest

Last reviewed: 31/08/2023

Next review date: 31/08/2026

Reviewer name(s): Cara Clink, Therapeutic Radiographer .

Document Id: TAM115

Related resources

Further information for Health Care Professionals

(Scroll down to see all references)


Further information for Patients

Self-management information