Malignant spinal cord compression (MSCC)

Key points about malignant spinal cord compression (MSCC)

  • MSCC is a rare condition where cancer has spread to your spinal cord causing compression around your spine.
  • The cancer can put pressure on your spinal cord and surrounding nerves creating nerve damage and symptoms of pain, numbness or weakness. 
  • Any cancers can spread to your spinal bones, but the most likely ones are breast cancer, lung cancer, prostate cancer, lymphoma and myeloma. 
  • Warning signs include severe or gradual back pain, back pain that spreads down your legs or arms and back pain that disturbs your sleep.
  • Treatment aims to reduce pressure and swelling around your spinal cord.
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Your spinal cord is a bundle of nerves that carry messages from your brain to your arms, body and legs. Malignant SCC occurs when cancers spread to your spinal bones and exert pressure on your spinal cord and the nerves around it. The pressure can cause damage to your nerves and can cause symptoms such as pain, numbness or weakness. This is an emergency and you need to seek urgent medical attention as it can cause permanent irreversible damage to your nerves. 

There are several cancers that can spread to your spinal cord. The more common cancers include:

Look out for the warning signs and symptoms of malignant SCC if you have cancer or a tumour. You may experience one of the following symptoms:

  • severe back pain not responding to pain killers, and changes in pain when you stand or lie down, cough or sneeze
  • back pain spreading down your legs or arms
  • back pain troubling you to sleep at night
  • mild and gradual back pain that is different from your normal back pain
  • weakness in both legs or arms
  • altered sensation in both legs or arms such as tingling, numbness or 'pins and needles'
  • feeling unsteady on your feet or legs giving way
  • bowel problems such as constipation 
  • problems with urination (peeing) such as urinary leakage or unable to pee at all.

If you notice any of the symptoms above, contact your doctor immediately. The earlier malignant SCC is diagnosed, the more effective the treatment will be. 

Your doctor will take a history, do a physical examination and request some tests based on your symptoms. This usually involves urgent scanning of your spine such as an MRI or CT scan, which is usually done in hospital. 

If you have malignant SCC, your doctor will discuss with you the best treatment options. These usually depend on the cause of the spinal cord compression, the type of cancer you have and your general health. Before treatment is started, your doctor may ask you about your wishes or whether you have any advance care plan. You may also be admitted to a hospital to receive treatment and be referred to a palliative care specialist.

Treatment aims to reduce swelling and pressure around your spinal cord. Your doctor will consider giving you steroids such as dexamethasone or prednisone to help reduce swelling and pressure on your nerves. If you have diabetes or any past problems with steroids, let your doctor know. You may also need radiotherapy or radiation treatment to destroy cancer cells around the area of compression. 

It can be scary to experience sudden weakness or altered sensation in malignant SCC. Talk through your feelings with your family members, whānau or health professionals taking care of you. Read more about how to talk about your feelings

Below are some support services and information for people affected by cancer and their family/whānau:

Emotions and cancer(external link) Cancer Society of NZ
How we can help(external link) Cancer Society of NZ
NZ cancer services – find a hospital/service near you(external link) Healthpoint, NZ
More cancer support groups

The following links provide further information about malignant SCC. Be aware that websites from other countries may have information that differs from New Zealand recommendations.  

Spinal cord compression(external link) Cancer Research, UK
Malignant spinal cord compression(external link) Northern Lincolnshire and Goole Hospitals NHS Foundation Trust, UK
Metastatic spinal cord compression (MSCC)(external link) University College Hospital, UK
Patients at risk of spinal cord compression(external link) Nelson Tasman Hospice, NZ, 2012


Clinical resources and guidelines

The palliative care handbook(external link) Hospice NZ, 2019
Serious illness conversation guide Aotearoa(external link) Health Quality & Safety Commission, NZ, 2019
Spinal cord compression management in the palliative patient(external link) Starship Clinical Guidelines, NZ, 2015

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Credits: Healthify editorial team. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Jarna Standen, Registered Nurse, Mercy Hospice, Auckland

Last reviewed:

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