The Management of Metastatic Spinal Cord Compression in Routine Clinical Practice.

Area of Science:

• Oncology
• Orthopedic Surgery
• Clinical Practice Research

Background:

• Clinical management of spinal metastatic disease (SMD) often lacks alignment with evidence-based recommendations.
• Understanding current practices and adherence to guidelines is crucial for improving patient outcomes.

Purpose of the Study:

• To assess the concordance between clinical management of SMD and evidence-based recommendations among specialists.
• To evaluate the awareness, interpretation, and application of established scoring systems and guidelines in routine practice.

Main Methods:

• A questionnaire survey was distributed to 80 specialists across Spanish Medical Societies.
• The survey explored routine practices, interpretation of the Spinal Instability Neoplastic Score (SINS) and Extended్ర Spinal Complications Score (ESCC), and agreement with Tokuhashi and SINS scales and NICE guidelines.
• Data were collected voluntarily and anonymously.

Main Results:

• Only 33.7% of hospitals had an SMD protocol or a specific multidisciplinary board.
• Familiarity with SINS was high (77.5%), but usage was lower (60%), with correct interpretation rates of 57.5-70.0%.
• ESCC score interpretation was lower (30.0-37.5%), despite >70% agreement with SINS, Tokuhashi, and NICE guideline recommendations. Significant variations existed across different practice settings and specialties.

Conclusions:

• While a majority of specialists recognize and agree with gold-standard treatment features for spinal cancer (SCC), there is a notable gap in their consistent application.
• Discrepancies in protocol implementation, scoring system usage, and interpretation highlight areas for targeted educational interventions and practice improvement initiatives.