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### What you need to know
Metastatic spinal cord compression (MSCC) is a well recognised complication of the spread of cancer to the vertebral column. Metastases to the spinal column occur in 3-5% of all people with cancer1 and can cause pain, vertebral collapse, and spinal cord compression. It is frequently an oncological or surgical emergency. Potential neurological damage can lead to irreversible loss of spinal cord function. Early diagnosis and intervention are necessary to reduce neurological consequences and can be achieved through early recognition and reporting of symptoms, effective referral pathways, urgent investigations, and prompt, appropriate treatment.
The 2008 NICE guideline on MSCC,2 updated in 2012, changed the way services are delivered in the UK. However, stakeholders involved in the 2018 surveillance process highlighted changes in evidence and practice, and where implementation of recommendations had been low. In 2023, a full update of the guidance was therefore