Initial management and disposition of metastatic spinal cord compression in the emergency department: a review of the literature.

backgroundMetastatic spinal cord compression (MSCC) is a serious medical emergency that can complicate the course of various malignancies, including prostate, breast, and lung cancers. Appropriate evaluation and effective management of MSCC early in the emergency department are necessary to minimize neurologic deterioration and optimize the trajectory of patient recovery.

methodsThis literature review examines and summarizes current evidence surrounding the emergency department approach for timely recognition, initial evaluation, and management of MSCC.

resultsA comprehensive clinical history, nerve root or spinal cord clinical examination, and urgent imaging procedures are fundamental for early diagnosis and initial management. The urgency of intervention depends on the rate of onset of motor deficits, which can progress during work-up. Patients should be stratified into subgroups: those requiring immediate surgery, those who can be treated with radiotherapy, and those who may be discharged for outpatient care. Some patients can be observed for 24 h to adjust the medical and/or surgical treatment. In most cases, systemic steroid administration with dexamethasone should be started immediately upon diagnosis, followed by a tapering course of oral dexamethasone. Selected patients should undergo surgical decompression with or without stabilization. A multidisciplinary approach involving both spinal surgeons and radiation oncologists is essential for diagnosis and stratification.

conclusionFor patients with MSCC, early and effective evaluation and intervention in the emergency department, through a coordinated multidisciplinary effort, are vital to optimizing patient outcomes.