Malignant spinal cord compression pathway: A new step toward standard of care for a critical oncological finding

Abstract

Background: Malignant cord compression syndrome (MCCS) must be addressed clinically using whole-spine magnetic resonance imaging in suspected patients and managed accordingly. Establishing a Malignant spinal cord compression pathway is crucial for addressing these patients sequentially with an immediate management plan. Here, we reported the outcomes of a Malignant spinal cord compression pathway and compared the results with those before its implementation. Methods: This is a prospective observational study where data collection was performed for patients with activated cord compression pathway between July 2021 and October 2022. Collected data was including demographics of patients, presenting symptoms, time of recorded clinical pathway activation and subsequent events including final management plan. Retrospective data collection was done for 52 patients whom were treated from the period between 2018-2019. Non-parametric test was used to compare medians for both groups. Results: In total, 170 patients were included, and 52 of them were treated based on positive magnetic resonance imaging (MRI) findings of Malignant spinal cord compression pathway between 2018 and 2019. Moreover, 118 patients were identified during the implementation of the cord compression pathway in 2020–2022. Three main targeted intervals were calculated in hours using medians and means: interval 1, time from cord compression suspicion to MRI; interval 2, MRI completion to MRI report; and interval 3, cord compression suspicion to intervention. In 2018–2019, medians of these three intervals were 9.5, 12, and 110 h, and in 2020–2022, they substantially decreased to 6, 3, and 24 h, respectively. An independent nonparametric test was performed to compare the medians, and statistically significant results were obtained for intervals between MRI completion and MRI report (p = 0.001) as well as between cord compression suspicion and intervention (p = 0.001). Conclusions: The use of the malignant spinal cord compression pathway effectively shortens the time needed for identifying patients at risk, reduces the time to report critical findings, and significantly shortens the interval between identification and treatment. In our study, clinical pathway reduced time needed to identify, diagnose and manage such disease.