Comprehensive guide to the diagnosis, management, and treatment of metastatic spinal cord compression syndrome

Spinal metastases are the most common tumors found in the neuraxis. They correspond to 90 % of all tumors at this level. The thoracic region is the most frequently affected area, followed by the lumbar region, with the cervical region being the least frequently affected place. Back pain is the most common symptom, appearing in up to 95 % of patients who present with spinal cord compression syndrome. The evaluation of patients with spinal cord compression syndrome is complex and requires an entire multidisciplinary team for diagnosis, management, and treatment. In the medical part, treatment is based on pain control with analgesic medications and the use of steroids, mainly dexamethasone, which has demonstrated efficacy and safety in the context of patients with spinal cord compression syndrome for functional recovery. Radiotherapy treatment is essential both as a definitive treatment and as a complementary treatment to surgery and although to date there are several treatment schemes, doses and fractions must be individualized based on the clinical context of each patient. On the other hand, metastatic spinal surgery is considered part of the definitive treatment, and although in a palliative context there are multiple approaches and indications for it. The importance of considering surgery is in those patients who are unstable since surgery, although it is not curative, poses a substantial improvement in symptoms as well as in pain recovery. We propose a diagnosis and treatment algorithm for patients with metastatic spinal cord compression syndrome in which decision-making is based on individualization and joint management by a multidisciplinary team. CLINICAL TRIAL NUMBER: not applicable.