Download SPINAL CORD COMPRESSION GUIDELINES

Spinal Cord Compression
Guidelines
October 2004
SPINAL CORD COMPRESSION GUIDELINES
Section 1
:
Signs and Symptoms
Section 2
:
Initial Treatment and Management
Section 3
:
Treatment and Management in inpatient unit
Section 4
:
Investigation Pathway
Section 5
:
Treatment Pathway following diagnosis of Spinal Cord Compression
Section 6
:
Rehabilitation Pathway
Section 7
:
Nursing Care
Section 8
:
Patient Information
Section 9
:
Continuing Care for patients who are paralysed
Section 10
:
Contributors
1
SECTION 1: SIGNS AND SYMPTOMS OF SPINAL CORD COMPRESSION
Key Point
The outcome of Spinal Cord Compression (SCC) is related to early treatment. While diagnosis
may be obvious in late disease, initial symptoms may be vague. A high index if suspicious must
be maintained.
1.1
Causes of Spinal Cord Compression (SCC)
SCC occurs when pressure on the cord leads to neurological dysfunction. Areas of spine
affected are thoracic (70%), lumbosacral (20%) and cervical (10%). In most cases onset
is gradual. Occasionally however onset is acute.
Pressure on the cord commonly results from local tumour spread either posteriorly from
a vertebral body or by a paravertebral tumour invading via the intervertebral foramen.
Metastatic involvement of vertebral bodies may lead to bone weakening and subsequent
fracture or collapse. Bone fragments may be displaced posteriorly and impinge on the
cord. This is associated with sudden onset of symptoms.
1.2
Signs and Symptoms
Signs and symptoms depend on the area of cord affected. As onset is gradual initial
symptoms maybe vague and diagnosis may be missed.
Common symptoms in the thoracic area are:Back pain (typically radicular)
Sensory disturbance in lower limbs
Urinary disturbance
Leg weakness
Signs are those of bilateral upper motor nerve lesion in the legs and a sensory level may
be detected.
Cervical cord involvement may be suspected if there are neurological symptoms or signs
in the arms.
In the lumbar spine compression may be below the level of the cord affecting the cauda
equina. This leads to nerve root pain in back and legs. Urinary disturbance may be a
feature. Signs are of a lower motor neurone lesion in the legs. There may be signs of
nerve root irritation shown by limited straight leg raising.
2
1.3
Practical Points
SCC should be suspected if there is:

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A change in the character or severity of back pain, worse on lying down.
Alteration in sensation
Urinary hesitancy
Diminished power of erection in men
Feelings of weakness or inco-ordination
Increasing radicular pain, worse on coughing, especially if affecting upper body
Pain worse on lying down.
Pain arising from thoracic area.
If the patient experiences two or more of the symptoms below it is probable that spinal
cord compression will exist:




Rapidly escalating pain which is difficult to control even with increasing dose of
opioids.
Acute sudden sensory and motor weakness defit
Acute bladder and sphincter dysfunction
Night pain/pain on lying down
History of primary tumour.
References/Bibliography
Hillier R., Wee B (1997) Palliative Management of Spinal Cord Compression
European Journal of Palliative Care 4(6) 189-192.
Spence R.A.J. and Johnston P.G. (eds) (2001) Oncology
Oxford University Press
The Royal Marsden Hospital (2003) Spinal Cord Compression Management (online) Available
on http://www.ctsevv/qmuc.ac.uk/marsden (accessed 30.7.03)
Tywcross R, Wilcock A. (2001) Symptom management in advanced cancer
3rd ed. Radcliffe Medical Press.
3
SECTION 2: INITIAL TREATMENT AND MANAGEMENT
2.1
Patients may present in a variety of health care settings to any health care professional.
For the purpose of the pathway it is assumed that the patient presents in primary care.
Majority of patients will have a pre-existing known malignancy however some may not
have a definite diagnosis. All patients irrespective of known malignancy require urgent
admission and assessment.
2.2
Where a patient has no history of primary malignancy they should be referred to the
nearest spinal surgery or neurology service. There is a spinal injury team on-call at
James Cook University Hospital which can be contacted through South Tees
Switchboard.
2.3
Commence on Dexamethasone 16mg immediately (slow iv if possible, subcutaneous or
oral whichever can be organised quicker). Intravenous Dexamethasone must be given
slowly to avoid sensations of perineal burning (Haas 2003).
2.4
Admit the patient to local Medical Assessment Unit (MAU). For patients in the
Hambleton & Richmondshire PCT who would usually be admitted to the Friarage
Hospital admit directly to MAU, oncology or the neurology unit at James Cook
University Hospital. This is because the Friarage Hospital does not have an MRI
Scanner and therefore admission to the Friarage may delay diagnosis to treatment time.
2.5
Role of Dexamethasone
High dose steroids should be offered to all patients where feasible. Steroids reduce peri
tumour oedema resulting in a reduction of pain, preservation of neurological function
and ultimately improve functional outcome after definitive treatment. High doses of
steroids may increase the incidence of gastric irritation and fluid retention. The
concurrent use of a proton pump inhibitor may be indicated especially if taking a nonsteroidal anti-inflammatory drug.
References/Bibliography
Doyle D., Hanks W.C. & MacDonald N (1998) Oxford Textbook of Palliative Medicine
2nd ed. Oxford University Press.
Haas F. (2003) Management of Malignant Spinal Cord Compression Nursing Times
Vol. 99 No. 15 pp 32-34.
Posner, J. (1995) Neurologic complications of cancer FA Davis. Philadelphia.
4
SECTION 3: TREATMENT AND MANAGEMENT IN INPATIENT UNIT
3.1
3.2
Responsibilities of Doctor on Admission

Patients should be seen urgently on admission. Delays on admission may result in
permanent deterioration of neurological functioning.

The neurological status should be recorded.

Dexamethasone should be administered if this has not already been undertaken by
the referring GP (See Section 2).

Inform senior medical staff of the patients admission and suspected diagnosis.

Organise urgent MRI scan. Some MRI units will only accept referrals from
registrars and above. Please refer to local trust policies. (See Section 3). Do not
waste unnecessary time by organising bone scans or x-rays.

Identify who the results of the MRI scan should be reported to and give necessary
contact details to MRI department. Complete request form as specified in Section 4.

Assess pain control and prescribe appropriate analgesia. Specialist Palliative Care
Teams are available to provide advice if required.

If the patient is unable to lie flat for 30 minutes because of pain, adequate sedation/
analgesia must be arranged prior to transfer to MRI department. Inadequate pain
control may result in the MRI scan not being carried out, unnecessary wasted time
for the radiology department and a delay in the treatment for the patient.
Responsibilities of doctor following results of MRI Scan
Scan demonstrating spinal cord compression

Organise for transfer to the Oncology Department at James Cook University Hospital
following discussion with oncologist.

Transfer should not be delayed and should be on the same day.
Negative scan for spinal cord compression

Further investigations may be required which should be organised in collaboration
with the consultant responsible for the patients care.

Pain and symptom control management should be instigated if not already done so.
Referral to the Specialist Palliative Care Team can be made if required.

Reduce and/or discontinue Dexamethasone.
5

Patients who were initially referred to MAU, oncology or neurology at James Cook
University Hospital from the Hambleton & Richmondshire PCT area should be
referred back to the MAU at the Friarage Hospital if considered appropriate and
necessary.
References/Bibliography
The Royal Marsden Hospital (2003) Spinal Cord Compression Management (online) Available
on http://www.ctsevv/qmuc.ac.uk/marsden (accessed 30.7.03)
6
SECTION 4: INVESTIGATION PATHWAY
MRI scanning is the gold standard investigation of choice. If bone scans and x-rays have
previously been undertaken they are useful in evaluating current problems however if they have
not been undertaken time should not be wasted in undertaking these investigations.
The MRI investigation should be requested urgently.
4.1
Contents of a request form

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4.2
Patient details
Patient location
Relevant clinical findings
History and nature of primary malignancy if known
History of previous radiotherapy and levels
History of previous surgery with details
Previous radiological investigations and results
Contact details of the referring practitioner i.e. bleep number or other contact details.
Referral Process
The doctor responsible for the patients care according to Trust policy, should contact the
radiologist or the MRI scan room to discuss priority and timing of the examination. The
request form will then be immediately delivered or faxed to the MRI Department. If the
radiologist has not been immediately available then the referring doctor should leave
details of who to contact if further information or discussion is required. NB this
information should also be included on the request form.
Some patients are unable to be safely imaged with MRI. These cases need to be
identified as part of the MRI referral process and alternative imaging should be discussed
with the radiologist.
4.3
MRI Examination

Patients with saddle anaesthesia, motor weakness or bladder and bowel dysfunction
will be scanned the same day, or immediately the following morning if after
radiology on call hours.

Patients without motor loss, no bladder or bowel dysfunction and only vague sensory
disturbance will normally be scanned within 48-72 hours unless there is progressive
neurological deterioration.
A standard MRI protocol of spinal cord compression will typically involve:

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Sagittal T1 and T2 (or STIR/FST2) images of the entire spine (cervical spine to
sacrum).
Axial images through any relevant areas of cord compression.
If there is no evidence of neural compression: consider the indications for evaluation
of the brain or post contrast T1 images of the spine to exclude intradural metastases.
7
4.4
NB If the patient is unable to lie flat for 30 minutes because of pain adequate
provision for analgesia and sedation must be arranged prior to transfer to MRI
Department. This will be the responsibility of the referring doctor who should liaise with
anaesthetist and the MRI department as appropriate. It may be necessary to give an
anxiolytic such as diazepam/lorazepam.
4.5
Reporting of MRI Scan
This will be reported at the earliest opportunity by the supervising radiologist. An
immediate report will be issued by either:
 A handwritten report within the patients case notes
OR
 Verbal communication with the referring clinician.
A subsequent formal report will be issued and filed with the patients file packet. When
necessary a second copy of the films will be sent with the patient to the inpatient unit.
8
SECTION 5: TREATMENT PATHWAY FOLLOWING DIAGNOSIS OF SPINAL
CORD COMPRESSION
In patients with a known malignancy there are several treatment options:

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

Dexamethasone (See section 2)
Decompression surgery
Radiotherapy
Chemotherapy
Patients following transfer from medical assessment units will be admitted into James Cook
University Hospital for assessment by an oncologist, if not already an inpatient there.
Patients where there is no histological diagnosis should be referred to a neuro or orthopaedic
surgeon for assessment.
Factors Influencing Choice of Treatment

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5.1
Overall picture of the patients’ problem, health status.
Acute deterioration of neurological functioning.
The site and histology of the primary tumour.
Fitness/performance status. NB Poor respiratory function may not be an indicator for not
treating as this may be overcome with further treatment.
Previous treatment: Has the radiotherapy tolerance dose to the spine already been reached.
Previous treatment with radiotherapy which does not ease pain.
Tokuhashi score of 5 or below will influence the choice of treatment (Tokuhaski et al 1990,
Enkaoua et al 1997, Tomita et al 2001). (See Appendix A)
Decompression Surgery and Stabilisation of the Spine
Surgery may be indicated in the following situations:


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Where the primary tumour is unknown.
Where there is relapse after radiation treatment.
In situations where there is spinal instability or vertebral displacement.
Where neurological symptoms progress during radiotherapy.
In paralysis of rapid onset.
Where tumours are not radiosensitive.
Factors limiting surgery include:

5.2
Very poor prognosis (less than 3 months survival) or performance status. Paraplegia
should not exclude referral especially if pain is an issue as quality of life may be
improved following surgery.
Obtaining on Orthopaedic Opinion
Oncologists are able to obtain advice from the surgeons on spinal injuries rota at James
Cook University Hospital through the switchboard at South Tees Hospitals NHS Trust.
24 hours advice is available through on-call surgeons.
9
Oncologists have the opportunity to discuss patients at the spinal injuries x-ray meetings
if timely enough. Meetings are held on a Wednesday lunchtime approximately 12.30pm
in the James Cook University Hospital. Contact spinal injuries surgeon secretaries for
further information.
It is advisable that patients referred for surgery have an ultrasound scan of upper
abdomen. This is to contribute to Tokuhashi score.
5.3
Radiotherapy
Radiotherapy is the main stay of treatment for malignant spinal cord compression.
(Ingham et al 1993)
Radiotherapy should be started within 24 hours to maximise recovery chances and
minimise function deficits. It is usual to give 5 fractions of radiotherapy.
The stability is assessed at MRI. Patients with an unstable spine need to be considered
for surgery. If the spine is unstable they should be nursed flat. The oncologist will
document in the current history sheets whether the spine is stable.
5.4
Chemotherapy
For patients with spinal cord compression caused by chemo responsive tumours e.g.
small cell lung cancer and lymphomas, treatment with cytotoxic drugs may be
considered. (Mallett & Dougherty 2000).
References/Bibliography
Enkaoua, E.A., Doursounian, L, Chatellier, G. Mabesoone, F., Aimard, T., Saillant, G. (1997)
Vertebral Metastases. Spine Vol. 22 No. 19 p 2293-2298.
Guerrero, D. (2003) The Management of Primary Spinal Cord Tumours Nursing Times Vol 99,
No. 42, p 28-31.
Ingham, J., Beveridge, A. and Cooney, N.J. (1993) The Management of Spinal Cord
Compression in patients with Advanced Malignancy. Journal of Pain and Symptom
Management Vol. 8, No. 1 p 1-7.
Klimo, P., Kestle, J.R.W and Schmidt, M.H. (2003) Treatment of Metastatic Epidural Disease:
A review of the literature. Neurosurgical focus Vol. 15 No. 5 p 1-9.
Mallett, J. & Dougherty, L. eds (2000) The Royal Marsden Hospital Manual of Clinical Nursing
Procedures 5th ed. London. Blackwell Science Limited.
Tokuhasi, Y., Matsuzaki, H., Toriyma, S., Kawano, H. & Ohsaka S. (1990) Scoring systems for
the Preoperative evaluation of metastatic spine tumour prognosis. Spine Vol. 15. No. 11 p 11101113.
Tomita, K., Kawahara, N., Kobayash, T., Yoshida, A., Murakami, H. & Akamaru, T. (2001)
Surgical Strategy for Spinal Metastases. Spine Vol. 26 No. 3 p 298-306
10
SECTION 6: REHABILITATION PATHWAY
Rehabilitation should begin as soon as possible however this will depend on the stability of the
spine and the patient’s pain.
Referral to physiotherapist and occupational therapist should be made for all patients
immediately following admission to hospital. Before teaching the patient active exercises, the
physiotherapist will need to check with the consultant responsible for the patients care if the
patient has a stable spine. If the patient doesn’t have a stable spine, the physiotherapist will seek
advice regards precautions and limitations to maintain patient safety. This should be
documented within the patients notes.
However, as soon as it is deemed safe, the patient should commence active leg exercises to
prevent the development of contractures, pressure sores and deep vein thromboses.
Referrals also need to be considered for social worker, dietitian and palliative care team.
6.1
Physiotherapy
6.1.1 Physiotherapy within Medical Assessment Unit
 A MRI scan will be used to confirm the presence and location of a spinal cord
compression, and assess the stability of the vertebral bodies and joints.
 If a cord compression is confirmed, the oncologist will decide on the most
appropriate course of management. If the patient is due to start radiotherapy,
he/she will usually have five fractions over five days and will remain on flat
bed rest until the course is complete. Exceptions are only made if the patient
is unable to tolerate being flat due to pain, respiratory disease, cardiac
problems etc.
 If the patient is to have surgery, either for decompression or stabilising of the
spine, the physiotherapist will liaise with the surgeon regarding pre and post
operative management.
 Upon initial assessment, the physiotherapist will perform a subjective
assessment regarding the patient’s previous health, mobility, social
circumstances, accommodation and medications. Then he/she will assess the
following:o
o
o
o
o
o
General condition
Isometric muscle strength
Sensation
Respiratory condition
Pain
Sphincter control
11
6.1.2
Physiotherapy During Radiotherapy Treatment

The patient will be kept on flat bed rest until radiotherapy is complete.
He/she will be assessed daily by the physiotherapist.

The physiotherapist will teach the patient breathing exercises to maintain
respiratory function and help to prevent the development of chest infections.
The patient will be seen daily to review the patient’s chest, but the breathing
exercises are to be performed hourly in order to be effective.

Active toe, foot and ankle exercises will be taught to maintain circulation and
tendo-achilles length. Static quadriceps and hamstring exercises will also be
taught to maintain muscle integrity. The physiotherapist will grade these
exercises depending on an individual patient’s ability. If the patient’s spine is
stable, active leg exercises will be taught, again graded to patient ability.

For patients with a cervical cord compression, the physiotherapist will liaise
with the oncologist/neurosurgeon regarding management and precautions. If
the spine is unstable, the orthotist should be contacted for an assessment for a
suitable collar.

If the patient has pain, the physiotherapist is able to provide advice on the use
of heat/cold therapy, Transcutaneous Electrical Nerve Stimulation (TENS)
and positioning.
6.1.3 Physiotherapy Following Radiotherapy Treatment
The stability of the spine should be documented by the oncologist in the medical
notes (see section 5.3). If the physiotherapist has any queries regarding limits or
contraindications, he/she will liaise with the oncologist. Otherwise he/she will
use the following protocol.

On the first day post radiotherapy, a full assessment of the patient’s lower
limb muscle strength will be carried out, and then, will be sat up to 45°, and if
tolerated for an hour, up to 90° whilst still in bed.

On the second day, the physiotherapist will assess the patient’s sitting
balance in bed. If he/she has independent sitting balance and more than
grade 3+ muscle strength, sit to stand will also be assessed. If able,
progression to dynamic standing and mobilising will be made.

If the patient doesn’t have static sitting balance. A hoist will need to be used,
though sensitivity should be exercised in introducing it to the patient.

If the patient has static sitting balance but is unable to stand, banana board
transfers will be practised.
12

6.2
By this point, it is usual that the occupational therapist will have become
involved and plans for discharge should be underway. The physiotherapist
shall liaise with the community team if necessary, to facilitate the patient’s
ensuing discharge.
Occupational Therapy

The occupational therapist will see the patient within two working days
admission to the Oncology Ward to undertake an initial assessment.

The occupational therapist will work closely with the physiotherapist and
develop their plan of care based upon the patients power within lower limbs,
mobility, sitting balance and ability to transfer.

Discussions regarding the discharge plan should be started on admission to
the oncology ward with the patient, carer and multi-disciplinary team (See
Section 9).

The occupational therapist will organise appropriate equipment necessary for
the patient during admission.

The occupational therapist will liaise with the District General
Hospital/Community Hospital occupational therapist and wheelchair therapist
regarding their assessment of discharge/ongoing care needs.

A rehabilitation programme should be established with regular assessments
and identification of when intervention should be initiated. The patient and
the multi-professional team should set short-term attainable goals to achieve
the optimum quality of life.
References/Bibliography
Hillier, R. & Wee, B. (1997) Palliative Management of Spinal Cord Compression. European
Journal of Palliative Care 4(6) p 189-192.
13
SECTION 7: NURSING CARE
(Adapted from The Royal Marsden Hospital Manual of Clinical Nursing Procedures).
7.1
7.2
7.3
Care on admission

Patients should be nursed flat until the stability of the spine is known; usually
following the results of the MRI scan. This is to prevent further compression of the
spinal cord which may result in deterioration of nerve functioning. The stability of
the spine should be documented in the patients current history sheets by a senior
medical practitioner indicating specific instructions for nursing/physiotherapy.

Explain and discuss all procedures and investigations with the patient and where
appropriate the carer. Reinforce that the aims of any intervention will be the relief of
pain and restoration of function if possible.

Refer to multi-professional team as appropriate. This should include:

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Physiotherapist
Occupational Therapist
Social Worker
Dietitian
Specialist Palliative Care Team
Moving and Handling

Ensure that assessment for manual handling is carried out.

When the patient needs to be moved e.g. to use a bed pan the patient should be
moved carefully to avoid twisting or torsion to the spine.

A full assessment of the patients ability to mobilise should be conducted by the
multi-professional team (See Section 5).
Assessment and Care Planning

Monitor and document vital signs, maintaining awareness of signs of spinal shock.
Report any signs of spinal shock to the medical team immediately.

Assess the patients neurological status including limb strength and sensation.

Assess alterations in elimination of urine and faeces – urgency, frequency, level of
control over function, retention, constipation and incontinence. Early autonomic and
nervous system involvement results in constipation and urinary retention.
Incontinence occurs with advanced autonomic nervous system involvement and
carries a poor prognosis.

Urinary catheterisation may be necessary if retention is present. Conduct procedure
using an aseptic technique and undertake catheter care according to local guidelines.
14

In the patient who is paralysed bowel care is important. Patients may become
severely constipated due to decreased mobility, spinal innervation, opioids and other
analgesics and anorexia. The use of laxatives may result in faecal incontinence
which can be problematic for carers to manage at home. Whilst in hospital the
patient should be established on a regular plan of bowel care as follows:
-
Allow the patient to become slightly constipated and use rectal preparations e.g.
suppositories or gentle enema to evacuate the bowel every 2-3 days depending on
the patients food intake and comfort.

The use of a faecal softener i.e. Docusate 1-2 capsules at night will prevent the faeces
becoming hard and dry therefore minimising discomfort for the patient. The dose
should be titrated against patient need.

The above regime should be monitored and adjusted depending on patient needs.

Stimulant laxatives should be avoided as this may result in uncontrolled and
unmanageable bowel function.

Undertake pain assessment using pain assessment tools according to local guidelines.
If required administer analgesia as prescribed observing effect and any side effects.
Consider use of non-pharmacological interventions such as adjusting position,
relaxation and massage. Referral to the Specialist Palliative Care Team may be
necessary to provide advice on pain control.

Assessment of skin condition. Pressure sores may develop if the patient spends time
in bed. Alteration in sensation may mean that stimuli of pain and pressure are not
perceived by the patient.
The use of pressure relieving aids should be assessed on an individual basis and balanced
with the risk of spinal cord transection. This should be assessed jointly with nursing and
medical teams, physiotherapist and occupational therapist.
7.4

Facilitate discussion on treatment options between the patient, carer and medical
team.

Acknowledge and assess the effects of diagnosis and disability on sexual functioning
facilitating discussion with the patient and partner if appropriate.

Discussions regarding the discharge plan should be started on admission to the
Oncology Ward or as soon as level of functioning is ascertained with the patient,
carer and multi-disciplinary team .
Treatments
7.4.1
Decompression Surgery and Stabilisation of the Spine

Provide pre and post operative care according to local guidelines.
15
7.4.2
Radiotherapy

Prepare the patient to receive daily radiotherapy treatments by providing
appropriate information and education. Support verbal information with
written/audio-visual information.

Monitor patient for side effects:
-
7.4.3
Skin – Erythema over treated area (refer to policy for the management of
acute radiotherapy induced skin reactions).
Oesophagitis – Administer analgesics and antacids as prescribed; provide
soft diet.
Nausea/vomiting – Administer antiemetics as prescribed.
Diarrhoea – Provide a low fibre diet and administer anti-diarrhoeal
medication as appropriate.
Dysuria – Increase fluid intake and exclude urinary tract infection by
taking an MSU.
Chemotherapy

Chemotherapy is occasionally used for patients who have a chemo responsive
tumour e.g. small cell lung cancer and lymphomas.

Prepare the patient to receive chemotherapy by assisting their understanding
of information regarding the rationale for chemotherapy and possible side
effects.
References/Bibliography
Mallett, J. & Dougherty, L. eds (2000) The Royal Marsden Hospital Manual of Clinical Nursing
Procedures 5th ed. London. Blackwell Science Limited.
Pension, J. & Fisher, R.A. (eds) (2002) Palliative Care for People with Cancer 3rd ed. London.
Arnold.
Skin care working party (2001) Policy for the management of acute radiotherapy induced skin
reactions Department of Radiotherapy & Oncology, James Cook University Hospital 2.7.01
16
SECTION 8: PATIENT INFORMATION

Early diagnosis is essential in order to ensure prompt treatment and preservation of
neurological functioning. Patients who are at risk of developing spinal cord compression
should be made aware of potential signs and advised to seek immediate medical help. (Haas
2003, Husband 1998, Held & Peahota 1993). This should be undertaken by the health care
professional who recognises that cord compression is a potential complication.

Patient information should be given verbally to ensure adequate psychological and physical
preparation for tests and interventions.

Ongoing assessment should be made to assess the patients understanding of any information
given by the multi-professional team. For some patients spinal cord compression means a
new diagnosis, for others it is a reminder of disease progression. Information should be
imparted with sensitivity and honesty. The majority of patients with dense paraplegia rarely
recover. (Hillier & Wee 1997)

Verbal information can be supported by written information or audio-visual information e.g.
Cancer Bacup, local information leaflets on radiotherapy, chemotherapy.

Information provided should be appropriate to patients needs and should take into
consideration the patients level of understanding i.e. learning disability, language or any
visual/hearing disabilities.
References/Bibliography
Cancer bacup (2004) What is Spinal Cord Compression?
http://www.cancerbacup.org.uk/Qas/393 (accessed 2.1.04)
(online) Available
at
Haas F. (2003) Management of Malignant Spinal Cord Compression Nursing Times
Vol 99 No. 15 pp 32 - 34.
Held J.L. & Peahota, A. (1993) Nursing Care of the Patient with Spinal Cord Compression
Oncology Nursing Forum Vol. 20 No. 10 pp 1507 – 1516.
Hillier R. & Wee B. (1997) Palliative Management of Spinal Cord Compression European
Journal of Palliative Care Vol. 4 No. 6 p 189 – 192.
Husband D.J. (1998) Malignant Spinal Cord Compression : Prospective Study of Delays in
Referral and Treatment. British Medical Journal Vol. 317 pp 18 – 21.
17
SECTION 9: CONTINUING CARE FOR PATIENTS WHO ARE PARALYSED

Patients will be preferably transferred to either their local district general hospital
community hospital if this is not James Cook University Hospital once treatment
completed for ongoing care and discharge planning. The co-ordination necessary
facilitate discharge home is complex as it requires liaison with a variety of agencies
ensure realistic care packages.

Communication between the oncology ward and the district general hospital should ensure
smooth transfer and continuity of care for patients. Copies of the patients care plans should
be forwarded with the patient, along with details of rehabilitation progress made and the
patients/carers wishes for ongoing care.

Discharge planning should include:
-
or
is
to
to
Assessment of the patients care needs.
Assessment of the carers needs.
Assessment of equipment and possible adaption needs.

Discharge planning should be timely and smoothly co-ordinated. It is likely to involve all
the members of the multi-disciplinary team. Community services e.g. GP, Community
nurses, Social worker, should be alerted as soon as possible of the patients/carers wishes to
be discharged home.

The carer should where appropriate be encouraged to participate in the patients care prior to
discharge home. This may include the care of catheters, management of medication, transfer
skills and the use of any equipment which will be necessary in the home. This is essential to
encourage independence and avoid the occurrence of a future crisis.
18
SECTION 10:
CONTRIBUTORS
NAME
TITLE
Sarah Jane Ashcroft
Dr. Trevor Birnie
Helen Boal
Liz Boal
Maureen Booth
David Burliston
Occupational Therapist
Consultant Palliative Care
Project Manager (Cancer Services)
Programme Manager
Dr. R. Campbell
Helen Caudren
Dr. Liz Dillon
Kate Gowans
Dr. Hardman
Tracey Haywood
Tracy Nevin
Mr. Papastefanou
Dr. Edwin Pugh
Dr. Neil Reynolds
Dr. D. Spence
Dr. Trewhella
Dr. Nick Wadd
Jane Walker
Christine Ward
ADDRESS
Senior physiotherapist in
Oncology & Haematology
Consultant Radiologist
Oncology OT
Consultant Radiologist
Senior Radiographer
Consultant Oncologist
Physiotherapist
Sister, Ward 33
Orthopaedic Surgeon
Consultant in Palliative Care
General Practitioner
Consultant Physician
Consultant Radiologist
Consultant Oncologist
Clinical Manager for Oncology
Nurses Consultant in Adult
Palliative Care
19
James Cook University Hospital
St. Teresa’s Hospice
Middlesbrough General Hospital
Middlesbrough General Hospital
Teesside Hospice
James Cook University Hospital
James Cook University Hospital
James Cook University Hospital
Darlington Memorial Hospital
James Cook University Hospital
James Cook University Hospital
James Cook University Hospital
University Hospital of North Tees
Middlesbrough General Hospital
Butterwick Hospice
Friarage Hospital
University Hospital of North Tees
James cook University Hospital
James Cook University Hospital
Hambleton and Richmondshire
Primary Care Trust
Appendix A
TOKUHASHI EVALUATION SYSTEM FOR THE PROGNOSIS OF
METASTATIC SPINE TUMOURS
Score
1.
2.
3.
4.
5.
6.
Good condition (performance status)
Poor
(PS 10-40%)
Moderate
(PS 50-70%)
Good
(PS 80-100%)
0
1
2
Number of extraspinal bone metastases foci
>3
1-2
0
0
1
2
Number of metastases in the vertebral body
>3
2
1
0
1
2
Metastases to the major internal organs
Unremovable
Removable
No metastases
0
1
2
Primary site of the cancer
Lung, stomach
Kidney, liver, uterus
Others, unidentified
Thyroid, prostate, breast
Rectum
0
1
2
Spinal cord palsy
Complete
Incomplete
None
0
1
2
Total = 12
20