Patchell MSCC trial

Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial.

Patchell RA, Tibbs PA, Regine WF, et al. Lancet (London, England) 2005 · PMID 16112300 · doi:10.1016/s0140-6736(05)66954-1

Question

Does surgical decompression plus radiotherapy improve walking ability over radiotherapy alone in metastatic spinal cord compression?

Design

Multicentre randomised trial stopped early for benefit.

Patients

Adults with MRI-confirmed single-level metastatic spinal cord compression, excluding radiosensitive tumours and long-standing paraplegia.

Intervention

Direct decompressive surgery followed by radiotherapy

Comparison

Radiotherapy alone

Primary outcome

Ability to walk after treatment

Key result

Significantly more surgical patients were ambulatory after treatment (84% versus 57%) and they retained walking ability for longer, with reduced steroid and opioid requirements.

Limitations

Small trial stopped early with strict selection criteria, so applicability to frail or multilevel disease is limited.

Impact on practice

Justifies surgical decompression and stabilisation for selected patients with MSCC, reflected in NICE MSCC guidance and the UK MSCC coordinator pathways.