Gradual, insidious onset of symptoms which have not improved with 4-6 weeks
Severe back pain, often worse at night disrupting sleep
Back pain exacerbated by increased by valsalva (e.g. sneezing, defaecation)
Localised pain on palpation
Systemic features - weight loss
History of malignancy
If there is suspicion of spinal tumour
Arrange urgent referral to a spinal surgery service, or perform urgent MRI (within 2 weeks)
Management of spinal metastases
Analgesia as per WHO 3-step ladder
Bisphosphonates
For all patients with vertebral involvement from myeloma or breast cancer
Consider in prostate cancer if other analgesia fails
Radiotherapy or surgery
Metastatic spinal cord compression
Compression of the spinal cord which occurs as a result of either direct pressure from a tumour, fracture/collapse of invaded vertebrae with resultant neurological compromise.
Clinical features: Back pain with red flags as above with neurological symptoms such as:
Upper/lower limb weakness
Sensory disturbance
Radicular pain
Autonomic features - bladder/bowel dysfunction
Features of cord/compression or CES
Investigations: MRI of whole spine within 24 hours of symptoms
Immediate management
Flat bed rest
Corticosteroids - 16mg daily of dexamethasone
PPI cover should be co-prescribed
Monitor BMs for steroid-induced hyperglycaemia
Contraindicated if significant suspicion of lymphoma
