Evidence-based management of metastatic spinal cord compression (MSCC): expert recommendations for standardizing care...

Metastatic spinal cord compression (MSCC) is a severe oncological emergency that may cause irreversible neurological damage if not recognized and treated promptly. In patients with known or suspected malignancy, spinal pain, particularly if progressive, or new motor, sensory, or sphincter symptoms should raise immediate suspicion of MSCC. MRI should be performed within 24 h of clinical suspicion. In patients with neurological signs or symptoms, initial emergency management should include immediate corticosteroid administration, urgent multidisciplinary assessment, and rapid initiation of definitive treatment. Surgery, when indicated, should be performed as early as feasible (ideally within 8-24 h when indicated); when surgery is not planned or not indicated, radiotherapy should be started promptly. This multidisciplinary expert opinion document provides practical recommendations to support standardized urgent pathways and coordinated multidisciplinary management of MSCC.