The Clinical Impact of a Multidisciplinary Strategy: Diagnostic and Therapeutic Flow-Chart for Vertebral Metastases with Spinal Cord Compression

Abstract

Introduction: Metastatic spinal cord compression (MSCC) is a life-threatening complication caused by the involvement of the spinal cord or nerve roots. It can result in severe neurological deficits, including paralysis, sensory loss, and bladder or bowel dysfunction, significantly affecting patients' quality of life. Prompt diagnosis and intervention are critical to minimizing these outcomes and improving neurological recovery. This study evaluates the efficacy of a diagnostic and therapeutic protocol introduced at our institution in 2022, designed to enhance early detection, optimize management, and improve outcomes for patients with MSCC. Materials and Methods: The protocol was developed through a multidisciplinary collaboration involving emergency physicians, oncologists, spine surgeons, neuroradiologists, and radiation oncologists. Each specialty contributed its expertise to create a streamlined approach emphasizing early symptom recognition, rapid diagnostic imaging, and timely therapeutic interventions, such as surgical decompression and radiotherapy. To assess the protocol's effectiveness, a retrospective analysis was conducted. Clinical data from the pre-implementation period (years 2019-2021) were compared to the post-implementation period (2022-2024). Results: The implementation of the algorithm significantly improved MSCC management, increasing outpatient consultations from 671 to 828 (+23%). Comparing the pre- to post-implementation periods, emergency consultations rose from 14% to 23%, while intrahospital consultations decreased from 20% to 16%. Surgical procedures increased slightly, from 60 to 66 (+10%), including 26 emergency surgeries (+4%) and 40 elective delayed surgeries (+14%). Conclusions: The introduction of a multidisciplinary diagnostic and therapeutic protocol significantly improved outpatient management of patients with metastatic spine disease, demonstrated by a significant increase in urgent outpatient consultations and a reduction in intrahospital consultations. The number of surgical interventions for metastatic spinal cord compression slightly increased after the protocol's adoption, although the proportion of elective surgeries remained unchanged. Neurological presentation at the time of surgery did not show a statistically significant difference between the pre- and post-implementation periods. These findings highlight the protocol's effectiveness in optimizing patient flow and triaging, while further research is needed to evaluate its long-term clinical impact.

Keywords: metastatic spinal cord compression; multidisciplinary; neurological deterioration; spinal cord.

Figure 1

The algorithm we introduced and began applying in 2022.

Figure 2

(A) Total number of patients evaluated by spine surgeons in our unit, revealing a 23% increase. (B) Percentage of these patients seen as intrahospital consultations (light grey bars), and as urgent consultations (dark grey bars). Comparing the pre-implementation to the post-implementation periods, intrahospital consultations decreased, and urgent consultations increased.

Figure 3

The graph illustrates the surgical modalities of patients operated on in our unit across two periods. The light grey bars represent emergency procedures, which increased by 4%, while the dark grey bars represent elective surgeries, which increased by 14%, comparing the pre-implementation and post-implementation periods. The black bars display the total number of surgeries performed, showing an overall 10% growth.

Figure 4

The graph illustrates the comparison of neurological deficits in urgent versus elective surgeries, before and after the protocol implementation. The light grey portion of each bar represents patients with severe neurological deficits, accounting for 84% and 88% of urgent cases, and 26% and 20% of elective cases, in the pre- and post-protocol periods respectively. The dark grey portion represents patients with mild or no neurological deficits.