Metastatic Spinal Cord Compression
Metastatic spinal cord compression is an oncologic emergency in advanced urological cancer — most relevantly prostate cancer; a vertebral metastasis compresses the cord, and the neurological status at the time you treat is roughly the status the patient keeps, so early MRI and high-dose steroids preserve the ability to walk and to control bladder and bowel.
The big picture
Metastatic spinal cord compression is an oncologic emergency in advanced urological cancer — most relevantly prostate cancer, which metastasises to bone (including the vertebrae). A vertebral metastasis grows into the epidural space and compresses the cord; if you don't act fast, the patient loses the ability to walk and to control bladder and bowel — permanently. The entire teaching point is that early diagnosis and treatment preserve function: the neurological status at the time you treat is roughly the status the patient keeps.
Suspect it on back pain in a cancer patient → start high-dose dexamethasone immediately (don't wait for imaging) → urgent whole-spine MRI → definitive surgery and/or radiotherapy. Speed determines outcome.
Mechanism pathway
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Diagnostic algorithm
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Board traps
MSCC is an oncologic emergency — early treatment preserves ambulation and bladder/bowel function; lost function rarely returns.
Back pain is the earliest, most common symptom — new back pain in a metastatic-cancer patient is MSCC until proven otherwise.
Most cord compressions come from vertebral-body (epidural) metastases.
Start high-dose dexamethasone immediately — do NOT wait for imaging.
Urgent MRI of the whole spine is the investigation of choice (often multi-level).
Definitive treatment = surgical decompression/stabilisation and/or radiotherapy; surgery for high-grade compression, instability, extensive bone involvement, or post-radiation recurrence.
Prostate cancer is the key urological cause (bone-metastasising).