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Spine

IMPLEMENTATION OF THE NICE GUIDELINES FOR METASTATIC CORD COMPRESSION. DO THEY MAKE A DIFFERENCE ?

Britspine, British Scoliosis Society (BSS), Society for Back Pain Research (SBPR), British Association of Spine Surgeons (BASS)



Abstract

Peninsula Spinal Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Foundation NHS Trust, Exeter, UK.

A retrospective audit in 2000 of cases presenting with metastatic cord compression (MSCC) was conducted. In June 2009 we introduced the role of MSCC coordinator. We present the preliminary results from a 6 month comparative audit and discuss whether implementation of the NICE Guidelines have improved the care pathway.

Prospective cohort study with retrospective controlled group.

Adults with suspected MSCC

Length of time to MR imaging

% referred for surgical opinion

Length of time on bed rest.

% undergoing surgery

Retrospective audit 2000

38 cases confirmed MSCC.

11 did not have MRI and were treated on the basis of clinical symptoms.

Average time from admission to MRI 42 hours.

8 patients (21%) referred for surgical opinion.

None had surgery

38 had radiotherapy.

Spinal stability documented on 1 patient.

5.5 days average bed rest

Prospective audit 2009

54 patients referred to co-ordinator as suspected MSCC.

52 had MRI and 2 had CT.

Average time from referral to MRI 41 hours.

Average time for patients with neurological deficit 7.6 hours.

54 patients (100%) referred for surgical opinion.

12 patients had surgery (22%).

100% patients had spinal stability documented.

Average length of time on bed rest 2 days.

It is uncertain whether these results are attributed to the introduction of the NICE guidelines or improved awareness of condition. However we feel that NICE guidelines have improved the care pathway of patients with MSCC.

Statement of ethics and interests: Study was approved and registered with audit department.