What does this guideline encompass?

This guideline elucidates the optimal approach to the management of patients presenting with spinal metastases, aligning with current standards of medical care. The following domains are addressed:

• Diagnosis: Prompt identification of spinal metastases and spinal cord compression, utilizing advanced imaging modalities such as MRI, alongside rigorous clinical evaluation of neurological impairment.
• Treatment: Strategic decision-making regarding surgical intervention, radiotherapy, and systemic therapies, encompassing indications, timing, and multidisciplinary coordination of care.
• Rehabilitation: Facilitating optimal recovery of function following spinal cord compression and enhancing quality of life, with particular emphasis on pain management and the restoration of mobility.
• Organisation of care: Streamlined referral pathways and effective collaboration between medical specialists (including oncologists, radiologists, neurosurgeons, orthopaedic surgeons) and rehabilitation services.

These recommendations are grounded in evidence-based diagnostic algorithms, tailored therapeutic strategies according to prognosis and tumor classification, and the structured interplay of expertise across disciplines.

Intended audience

This guideline is directed towards all healthcare professionals operating within secondary and tertiary care settings and involved in the management of adult patients with (presumed) spinal metastases. This encompasses, though is not limited to, radiation oncologists, pulmonologists, internists, other oncologists, radiologists, neurologists, neurosurgeons, orthopedic surgeons, rehabilitation physicians, and pain specialists.

For patients

Spinal metastases refer to the dissemination of malignant cells to the vertebral column. Such metastases may, in certain instances, exert pressure upon the spinal cord or nerve roots, precipitating symptoms such as pain, motor weakness, or, in severe cases, paralysis. This guideline serves as a clinical aid to ensure expeditious diagnosis and management - whether by means of imaging, radiotherapy, surgery, or pharmacological intervention - with the ultimate aim of ameliorating symptoms and enhancing quality of life. Rehabilitation is integral, offering structured support for the reclamation of strength and functional independence.

For reliable patient information, please consult www.thuisarts.nl (Dutch-language health resource).

Development of this guideline

The inception of this guideline can be attributed to the Dutch Society of Neurology (NVN). Its formulation was overseen by pertinent scientific associations within a multidisciplinary working group, comprising representatives from neurology, neurosurgery, radiotherapy, orthopedics, internal medicine, respiratory medicine (including specialists in tuberculosis), radiology, oncology, and rehabilitation medicine. The perspective of patients was incorporated through engagement with patient advocacy organizations and public consultation.

Implementation resources

A suite of resources is available to facilitate the effective implementation of this guideline:

Clinical decision-making flowcharts (Flowchart of diagnostics and Flowchart of treatment) on richtlijnendatabase.nl for user-friendly access to recommendations

Status of the guideline

This guideline forms part of a modular compendium subject to periodic review and revision in light of emerging scientific evidence or professional consensus. The most current version is accessible via the richtlijnendatabase.nl.

 Klik hier om het in het Nederlands te bekijken.