Malignant spinal cord compression (MSCC) — radiologic compression of cord/cauda equina by...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-ONCOLOGIC-EMERGENCY-CORD-COMPRESSION`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	None declared
Sources	`SRC-NCCN-BCELL-2025` `SRC-NCCN-CNS-2025`

Red Flag Origin

Definition	Malignant spinal cord compression (MSCC) — radiologic compression of cord/cauda equina by epidural tumor with neurologic deficit (motor weakness, sensory level, sphincter dysfunction) or impending deficit (severe back pain + radiologic compression). Triggers immediate dexamethasone 10 mg IV bolus → 16 mg/day, urgent MRI whole spine, surgical decompression within 24h if life expectancy ≥3 months + single-level disease (Patchell trial), and/or RT 8 Gy x1 or 20 Gy/5 fx (SCORAD), and disease-directed systemic therapy.
Clinical direction	intensify
Category	oncologic-emergency

Trigger Logic

{
  "any_of": [
    {
      "finding": "spinal_cord_compression",
      "value": true
    },
    {
      "finding": "epidural_compression_with_deficit",
      "value": true
    },
    {
      "finding": "cauda_equina_syndrome",
      "value": true
    }
  ],
  "type": "composite_score"
}

Notes

Patchell 2005 RCT — surgery + RT > RT alone for ambulatory recovery in single-level epidural compression with life expectancy >3 mo. SCORAD III (Hoskin 2019) — 8 Gy x1 non-inferior to 20 Gy/5 fx for ambulatory metastatic spinal cord compression, simpler. SINS score (Spinal Instability Neoplastic Score) ≥7 → surgical consult; ≥13 → unstable. Tumor types vary: lymphoma, MM, breast, prostate, lung most common; chemosensitive (lymphoma, MM, SCLC, germ cell) — favor chemo-first if asymptomatic-borderline; chemoresistant (RCC, melanoma, sarcoma) — favor surgery + RT. Time-to-treatment is the critical predictor of recovery — onset of paraplegia <48h prior to decompression has poor recovery; >48h paraplegic patients rarely ambulate again. Steroids: dex 96 mg/d x3d → taper (Vecht 1989) for high-risk; standard 16 mg/d adequate in less-severe.

Used By

No reverse references found in the YAML corpus.