When should I refer a patient with suspected MSCC to a specialist, and what information should I include in the referral?

When to refer: Immediately refer a patient with a past or current diagnosis of cancer who presents with symptoms or signs suggestive of spinal cord compression (such as bladder or bowel dysfunction, gait disturbance, limb weakness, neurological signs of spinal cord or cauda equina compression, numbness, paraesthesia, or radicular pain) to the MSCC coordinator or specialist as an oncological emergency. This referral should be made without delay and within 24 hours to ensure urgent assessment and management. For patients without a known cancer diagnosis but with pain characteristics suggesting spinal metastases and suspicion of cancer, refer urgently for oncology assessment.

Information to include in the referral: The referral should include the patient's cancer history (past or current diagnosis), detailed description of symptoms and signs suggestive of spinal cord compression or spinal metastases (including pain characteristics such as severe unremitting back pain, progressive or mechanical pain, pain aggravated by straining or at night, localised tenderness, and neurological symptoms), and any relevant imaging or clinical findings. Also include any neurological deficits, bladder or bowel dysfunction, gait disturbances, and any prior investigations or treatments related to the spine or cancer.

Early immobilisation advice and the urgency of MRI imaging (to be performed as soon as possible and within 24 hours) should be communicated to the specialist team to guide immediate management.

Ensure the referral highlights the need for urgent MRI imaging and specialist input to confirm diagnosis and initiate treatment promptly.

These steps align with NICE guidelines on spinal metastases and metastatic spinal cord compression to optimise patient outcomes.