🔑 Key Learning

  • Extradural metastases from breast, prostate, thyroid, kidney, lung, or stomach are the most common spinal tumours
  • Red flags: nocturnal back pain, age > 50, weight loss, systemic features
  • Urgent MRI if tumour or compression suspected
  • MSCC presents with back pain and neurological/autonomic dysfunction
    • Dexamethasone + urgent whole spine MRI

🧬 Pathophysiology

  • Spinal tumours can be:
    • Extradural (most common) – usually metastatic: Breast, Prostate, Lung, Thyroid, Stomach, Kidney
    • Intradural – meningiomas, ependymomas, astrocytomas
  • MSCC = spinal cord compression from:
    • Direct tumour pressure
    • Collapse of weakened vertebrae

🚩 Red Flag Features

  • Age > 50
  • Gradual, progressive back pain not improving after 4–6 weeks
  • Severe night pain, waking from sleep
  • Pain on valsalva – sneezing, straining
  • Localised vertebral tenderness
  • Systemic features – weight loss, fatigue
  • Known malignancy history

➡️ Arrange urgent MRI spine or spinal referral (within 2 weeks)

👀 Clinical Features of MSCC

  • Back pain + any of the following:
    • Limb weakness (UMN/LMN signs)
    • Radicular pain
    • Sensory loss
    • Bladder/bowel dysfunction (autonomic)
    • Signs of spinal cord or cauda equina compression

🧪 Investigations

  • MRI whole spine – within 24 hours of symptom onset

💊 Immediate Management (if MSCC suspected)

  • Flat bed rest
  • Dexamethasone 16mg/day PO/IV
    • Co-prescribe PPI
    • Monitor BMs for steroid-induced hyperglycaemia
    • Avoid steroids if lymphoma suspected
  • Urgent MRI within 24 hours

💊 Further Management

  • Radiotherapy – for radiosensitive tumours
  • Surgical decompression/stabilisation – if indicated
  • Analgesia – WHO pain ladder
  • Bisphosphonates:
    • Myeloma or breast cancer with vertebral involvement
    • Consider in prostate cancer if other analgesia fails

📝 Exam Clues & Clinchers

  • Back pain + history of breast/prostate cancer → consider spinal metastasis