510 lines
140 KiB
Text
510 lines
140 KiB
Text
<!DOCTYPE html>
|
|
<html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" class="no-js no-jr">
|
|
<head>
|
|
<!-- For pinger, set start time and add meta elements. -->
|
|
<script type="text/javascript">var ncbi_startTime = new Date();</script>
|
|
|
|
<!-- Logger begin -->
|
|
<meta name="ncbi_db" content="books">
|
|
<meta name="ncbi_pdid" content="book-toc">
|
|
<meta name="ncbi_acc" content="NBK595815">
|
|
<meta name="ncbi_domain" content="niceng234er2">
|
|
<meta name="ncbi_report" content="reader">
|
|
<meta name="ncbi_type" content="fulltext">
|
|
<meta name="ncbi_objectid" content="">
|
|
<meta name="ncbi_pcid" content="/NBK595815/?report=reader">
|
|
<meta name="ncbi_pagename" content="Evidence review for service configuration and delivery (management and rehabilitation) - NCBI Bookshelf">
|
|
<meta name="ncbi_bookparttype" content="toc">
|
|
<meta name="ncbi_app" content="bookshelf">
|
|
<!-- Logger end -->
|
|
|
|
<!--component id="Page" label="meta"/-->
|
|
<script type="text/javascript" src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.boots.min.js"> </script><title>Evidence review for service configuration and delivery (management and rehabilitation) - NCBI Bookshelf</title>
|
|
<meta charset="utf-8">
|
|
<meta name="apple-mobile-web-app-capable" content="no">
|
|
<meta name="viewport" content="initial-scale=1,minimum-scale=1,maximum-scale=1,user-scalable=no">
|
|
<meta name="jr-col-layout" content="1">
|
|
<meta name="robots" content="INDEX,FOLLOW,NOARCHIVE,NOIMAGEINDEX">
|
|
<meta name="citation_title" content="Evidence review for service configuration and delivery (management and rehabilitation)">
|
|
<meta name="citation_publisher" content="National Institute for Health and Care Excellence (NICE)">
|
|
<meta name="citation_date" content="2023/09">
|
|
<meta name="citation_pmid" content="37820021">
|
|
<meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK595815/">
|
|
<meta name="citation_keywords" content="Spinal Neoplasms">
|
|
<meta name="citation_keywords" content="Spinal Cord Neoplasms">
|
|
<meta name="citation_keywords" content="Spinal Cord Compression">
|
|
<meta name="citation_keywords" content="Rehabilitation">
|
|
<meta name="citation_keywords" content="Delivery of Health Care">
|
|
<meta name="citation_keywords" content="Continuity of Patient Care">
|
|
<meta name="citation_keywords" content="Patient Care Management">
|
|
<meta name="citation_keywords" content="Humans">
|
|
<meta name="citation_keywords" content="Review">
|
|
<link rel="schema.DC" href="http://purl.org/DC/elements/1.0/">
|
|
<meta name="DC.Title" content="Evidence review for service configuration and delivery (management and rehabilitation)">
|
|
<meta name="DC.Type" content="Text">
|
|
<meta name="DC.Publisher" content="National Institute for Health and Care Excellence (NICE)">
|
|
<meta name="DC.Date" content="2023/09">
|
|
<meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK595815/">
|
|
<meta name="og:title" content="Evidence review for service configuration and delivery (management and rehabilitation)">
|
|
<meta name="og:type" content="book">
|
|
<meta name="og:url" content="https://www.ncbi.nlm.nih.gov/books/NBK595815/">
|
|
<meta name="og:site_name" content="NCBI Bookshelf">
|
|
<meta name="og:image" content="https://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-niceng234er2-lrg.png">
|
|
<meta name="twitter:card" content="summary">
|
|
<meta name="twitter:site" content="@ncbibooks">
|
|
<meta name="bk-non-canon-loc" content="/books/n/niceng234er2/toc/?report=reader">
|
|
<link rel="canonical" href="https://www.ncbi.nlm.nih.gov/books/NBK595815/">
|
|
<link href="https://fonts.googleapis.com/css?family=Archivo+Narrow:400,700,400italic,700italic&subset=latin" rel="stylesheet" type="text/css">
|
|
<link rel="stylesheet" href="/corehtml/pmc/jatsreader/ptpmc_3.22/css/libs.min.css">
|
|
<link rel="stylesheet" href="/corehtml/pmc/jatsreader/ptpmc_3.22/css/jr.min.css">
|
|
<meta name="format-detection" content="telephone=no">
|
|
<link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books.min.css" type="text/css">
|
|
<link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css//books_print.min.css" type="text/css" media="print">
|
|
<link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books_reader.min.css" type="text/css">
|
|
<style type="text/css">p a.figpopup{display:inline !important} .bk_tt {font-family: monospace} .first-line-outdent .bk_ref {display: inline} .body-content h2, .body-content .h2 {border-bottom: 1px solid #97B0C8} .body-content h2.inline {border-bottom: none} a.page-toc-label , .jig-ncbismoothscroll a {text-decoration:none;border:0 !important} .temp-labeled-list .graphic {display:inline-block !important} .temp-labeled-list img{width:100%}</style>
|
|
|
|
<link rel="shortcut icon" href="//www.ncbi.nlm.nih.gov/favicon.ico">
|
|
<meta name="ncbi_phid" content="CE8EFE7F7D6CC0C100000000001D0018.m_5">
|
|
<meta name='referrer' content='origin-when-cross-origin'/><link type="text/css" rel="stylesheet" href="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/css/3852956/3849091.css"></head>
|
|
<body>
|
|
<!-- Book content! -->
|
|
|
|
|
|
<div id="jr" data-jr-path="/corehtml/pmc/jatsreader/ptpmc_3.22/"><div class="jr-unsupported"><table class="modal"><tr><td><span class="attn inline-block"></span><br />Your browser does not support the NLM PubReader view.<br />Go to <a href="/pmc/about/pr-browsers/">this page</a> to see a list of supported browsers<br />or return to the <br /><a href="/books/NBK595815/?report=classic">regular view</a>.</td></tr></table></div><div id="jr-ui" class="hidden"><nav id="jr-head"><div class="flexh tb"><div id="jr-tb1"><a id="jr-links-sw" class="hidden" title="Links"><svg xmlns="http://www.w3.org/2000/svg" version="1.1" x="0px" y="0px" viewBox="0 0 70.6 85.3" style="enable-background:new 0 0 70.6 85.3;vertical-align:middle" xml:space="preserve" width="24" height="24">
|
|
<style type="text/css">.st0{fill:#939598;}</style>
|
|
<g>
|
|
<path class="st0" d="M36,0C12.8,2.2-22.4,14.6,19.6,32.5C40.7,41.4-30.6,14,35.9,9.8"></path>
|
|
<path class="st0" d="M34.5,85.3c23.2-2.2,58.4-14.6,16.4-32.5c-21.1-8.9,50.2,18.5-16.3,22.7"></path>
|
|
<path class="st0" d="M34.7,37.1c66.5-4.2-4.8-31.6,16.3-22.7c42.1,17.9,6.9,30.3-16.4,32.5h1.7c-66.2,4.4,4.8,31.6-16.3,22.7 c-42.1-17.9-6.9-30.3,16.4-32.5"></path>
|
|
</g>
|
|
</svg> Books</a></div><div class="jr-rhead f1 flexh"></div><div id="jr-tb2"><a id="jr-bkhelp-sw" class="btn wsprkl hidden" title="Help with NLM PubReader">?</a><a id="jr-help-sw" class="btn wsprkl hidden" title="Settings and typography in NLM PubReader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 512 512" preserveAspectRatio="none"><path d="M462,283.742v-55.485l-29.981-10.662c-11.431-4.065-20.628-12.794-25.274-24.001 c-0.002-0.004-0.004-0.009-0.006-0.013c-4.659-11.235-4.333-23.918,0.889-34.903l13.653-28.724l-39.234-39.234l-28.72,13.652 c-10.979,5.219-23.68,5.546-34.908,0.889c-0.005-0.002-0.01-0.003-0.014-0.005c-11.215-4.65-19.933-13.834-24-25.273L283.741,50 h-55.484l-10.662,29.981c-4.065,11.431-12.794,20.627-24.001,25.274c-0.005,0.002-0.009,0.004-0.014,0.005 c-11.235,4.66-23.919,4.333-34.905-0.889l-28.723-13.653l-39.234,39.234l13.653,28.721c5.219,10.979,5.545,23.681,0.889,34.91 c-0.002,0.004-0.004,0.009-0.006,0.013c-4.649,11.214-13.834,19.931-25.271,23.998L50,228.257v55.485l29.98,10.661 c11.431,4.065,20.627,12.794,25.274,24c0.002,0.005,0.003,0.01,0.005,0.014c4.66,11.236,4.334,23.921-0.888,34.906l-13.654,28.723 l39.234,39.234l28.721-13.652c10.979-5.219,23.681-5.546,34.909-0.889c0.005,0.002,0.01,0.004,0.014,0.006 c11.214,4.649,19.93,13.833,23.998,25.271L228.257,462h55.484l10.595-29.79c4.103-11.538,12.908-20.824,24.216-25.525 c0.005-0.002,0.009-0.004,0.014-0.006c11.127-4.628,23.694-4.311,34.578,0.863l28.902,13.738l39.234-39.234l-13.66-28.737 c-5.214-10.969-5.539-23.659-0.886-34.877c0.002-0.005,0.004-0.009,0.006-0.014c4.654-11.225,13.848-19.949,25.297-24.021 L462,283.742z M256,331.546c-41.724,0-75.548-33.823-75.548-75.546s33.824-75.547,75.548-75.547 c41.723,0,75.546,33.824,75.546,75.547S297.723,331.546,256,331.546z"></path></svg></a><a id="jr-fip-sw" class="btn wsprkl hidden" title="Find"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 550 600" preserveAspectRatio="none"><path fill="none" stroke="#000" stroke-width="36" stroke-linecap="round" style="fill:#FFF" d="m320,350a153,153 0 1,0-2,2l170,170m-91-117 110,110-26,26-110-110"></path></svg></a><a id="jr-cmap-sw" class="btn wsprkl hidden" title="Table of Contents"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M20,20h10v8H20V20zM36,20h44v8H36V20zM20,37.33h10v8H20V37.33zM36,37.33h44v8H36V37.33zM20,54.66h10v8H20V54.66zM36,54.66h44v8H36V54.66zM20,72h10v8 H20V72zM36,72h44v8H36V72z"></path></svg></a></div></div></nav><nav id="jr-dash" class="noselect"><nav id="jr-dash" class="noselect"><div id="jr-pi" class="hidden"><a id="jr-pi-prev" class="hidden" title="Previous page"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M75,30 c-80,60 -80,0 0,60 c-30,-60 -30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Prev</text></svg></a><div class="pginfo">Page <i class="jr-pg-pn">0</i> of <i class="jr-pg-lp">0</i></div><a id="jr-pi-next" class="hidden" title="Next page"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M25,30c80,60 80,0 0,60 c30,-60 30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Next</text></svg></a></div><div id="jr-is-tb"><a id="jr-is-sw" class="btn wsprkl hidden" title="Switch between Figures/Tables strip and Progress bar"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><rect x="10" y="40" width="20" height="20"></rect><rect x="40" y="40" width="20" height="20"></rect><rect x="70" y="40" width="20" height="20"></rect></svg></a></div><nav id="jr-istrip" class="istrip hidden"><a id="jr-is-prev" href="#" class="hidden" title="Previous"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M80,40 60,65 80,90 70,90 50,65 70,40z M50,40 30,65 50,90 40,90 20,65 40,40z"></path><text x="35" y="25" textLength="60" style="font-size:25px">Prev</text></svg></a><a id="jr-is-next" href="#" class="hidden" title="Next"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M20,40 40,65 20,90 30,90 50,65 30,40z M50,40 70,65 50,90 60,90 80,65 60,40z"></path><text x="15" y="25" textLength="60" style="font-size:25px">Next</text></svg></a></nav><nav id="jr-progress"></nav></nav></nav><aside id="jr-links-p" class="hidden flexv"><div class="tb sk-htbar flexh"><div><a class="jr-p-close btn wsprkl">Done</a></div><div class="title-text f1">NCBI Bookshelf</div></div><div class="cnt lol f1"><a href="/books/">Home</a><a href="/books/browse/">Browse All Titles</a><a class="btn share" target="_blank" rel="noopener noreferrer" href="https://www.facebook.com/sharer/sharer.php?u=https://www.ncbi.nlm.nih.gov/books/NBK595815/"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 33 33" style="vertical-align:middle" width="24" height="24" preserveAspectRatio="none"><g><path d="M 17.996,32L 12,32 L 12,16 l-4,0 l0-5.514 l 4-0.002l-0.006-3.248C 11.993,2.737, 13.213,0, 18.512,0l 4.412,0 l0,5.515 l-2.757,0 c-2.063,0-2.163,0.77-2.163,2.209l-0.008,2.76l 4.959,0 l-0.585,5.514L 18,16L 17.996,32z"></path></g></svg> Share on Facebook</a><a class="btn share" target="_blank" rel="noopener noreferrer" href="https://twitter.com/intent/tweet?url=https://www.ncbi.nlm.nih.gov/books/NBK595815/&text=Evidence%20review%20for%20service%20configuration%20and%20delivery%20(management%20and%20rehabilitation)"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 33 33" style="vertical-align:middle" width="24" height="24"><g><path d="M 32,6.076c-1.177,0.522-2.443,0.875-3.771,1.034c 1.355-0.813, 2.396-2.099, 2.887-3.632 c-1.269,0.752-2.674,1.299-4.169,1.593c-1.198-1.276-2.904-2.073-4.792-2.073c-3.626,0-6.565,2.939-6.565,6.565 c0,0.515, 0.058,1.016, 0.17,1.496c-5.456-0.274-10.294-2.888-13.532-6.86c-0.565,0.97-0.889,2.097-0.889,3.301 c0,2.278, 1.159,4.287, 2.921,5.465c-1.076-0.034-2.088-0.329-2.974-0.821c-0.001,0.027-0.001,0.055-0.001,0.083 c0,3.181, 2.263,5.834, 5.266,6.438c-0.551,0.15-1.131,0.23-1.73,0.23c-0.423,0-0.834-0.041-1.235-0.118 c 0.836,2.608, 3.26,4.506, 6.133,4.559c-2.247,1.761-5.078,2.81-8.154,2.81c-0.53,0-1.052-0.031-1.566-0.092 c 2.905,1.863, 6.356,2.95, 10.064,2.95c 12.076,0, 18.679-10.004, 18.679-18.68c0-0.285-0.006-0.568-0.019-0.849 C 30.007,8.548, 31.12,7.392, 32,6.076z"></path></g></svg> Share on Twitter</a></div></aside><aside id="jr-cmap-p" class="hidden flexv"><div class="tb sk-htbar flexh"><div><a class="jr-p-close btn wsprkl">Done</a></div><div class="title-text f1">In Page Navigation</div></div><div class="cnt lol f1"><a href="/books/n/niceercollect/?report=reader">NICE Evidence Reviews Collection</a><a class="current">Title Information</a></div></aside><aside id="jr-help-p" class="hidden flexv"><div class="tb sk-htbar flexh"><div><a class="jr-p-close btn wsprkl">Done</a></div><div class="title-text f1">Settings</div></div><div class="cnt f1"><div id="jr-typo-p" class="typo"><div><a class="sf btn wsprkl">A-</a><a class="lf btn wsprkl">A+</a></div><div><a class="bcol-auto btn wsprkl"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 200 100" preserveAspectRatio="none"><text x="10" y="70" style="font-size:60px;font-family: Trebuchet MS, ArialMT, Arial, sans-serif" textLength="180">AUTO</text></svg></a><a class="bcol-1 btn wsprkl"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M15,25 85,25zM15,40 85,40zM15,55 85,55zM15,70 85,70z"></path></svg></a><a class="bcol-2 btn wsprkl"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M5,25 45,25z M55,25 95,25zM5,40 45,40z M55,40 95,40zM5,55 45,55z M55,55 95,55zM5,70 45,70z M55,70 95,70z"></path></svg></a></div></div><div class="lol"><a class="" href="/books/NBK595815/?report=classic">Switch to classic view</a><a href="/books/n/niceng234er2/pdf/">PDF (1.1M)</a><a href="/books/n/niceng234er2/toc/?report=printable">Print View</a></div></div></aside><aside id="jr-bkhelp-p" class="hidden flexv"><div class="tb sk-htbar flexh"><div><a class="jr-p-close btn wsprkl">Done</a></div><div class="title-text f1">Help</div></div><div class="cnt f1 lol"><a id="jr-helpobj-sw" data-path="/corehtml/pmc/jatsreader/ptpmc_3.22/" data-href="/corehtml/pmc/jatsreader/ptpmc_3.22/img/bookshelf/help.xml" href="">Help</a><a href="mailto:info@ncbi.nlm.nih.gov?subject=PubReader%20feedback%20%2F%20NBK595815%20%2F%20sid%3ACE8B5AF87C7FFCB1_0191SID%20%2F%20phid%3ACE8EFE7F7D6CC0C100000000001D0018.4">Send us feedback</a><a id="jr-about-sw" data-path="/corehtml/pmc/jatsreader/ptpmc_3.22/" data-href="/corehtml/pmc/jatsreader/ptpmc_3.22/img/bookshelf/about.xml" href="">About PubReader</a></div></aside><aside id="jr-objectbox" class="thidden hidden"><div class="jr-objectbox-close wsprkl">✘</div><div class="jr-objectbox-inner cnt"><div class="jr-objectbox-drawer"></div></div></aside><nav id="jr-pm-left" class="hidden"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 40 800" preserveAspectRatio="none"><text font-stretch="ultra-condensed" x="800" y="-15" text-anchor="end" transform="rotate(90)" font-size="18" letter-spacing=".1em">Previous Page</text></svg></nav><nav id="jr-pm-right" class="hidden"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 40 800" preserveAspectRatio="none"><text font-stretch="ultra-condensed" x="800" y="-15" text-anchor="end" transform="rotate(90)" font-size="18" letter-spacing=".1em">Next Page</text></svg></nav><nav id="jr-fip" class="hidden"><nav id="jr-fip-term-p"><input type="search" placeholder="search this page" id="jr-fip-term" autocorrect="off" autocomplete="off" /><a id="jr-fip-mg" class="wsprkl btn" title="Find"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 550 600" preserveAspectRatio="none"><path fill="none" stroke="#000" stroke-width="36" stroke-linecap="round" style="fill:#FFF" d="m320,350a153,153 0 1,0-2,2l170,170m-91-117 110,110-26,26-110-110"></path></svg></a><a id="jr-fip-done" class="wsprkl btn" title="Dismiss find">✘</a></nav><nav id="jr-fip-info-p"><a id="jr-fip-prev" class="wsprkl btn" title="Jump to previuos match">◀</a><button id="jr-fip-matches">no matches yet</button><a id="jr-fip-next" class="wsprkl btn" title="Jump to next match">▶</a></nav></nav></div><div id="jr-epub-interstitial" class="hidden"></div><div id="jr-content"><article data-type="main"><div class="main-content lit-style"><div class="fm-sec bkr_bottom_sep"><div class="bkr_thumb"><a href="https://www.nice.org.uk" title="National Institute for Health and Care Excellence (NICE)" class="img_link icnblk_img" ref="pagearea=logo&targetsite=external&targetcat=link&targettype=publisher"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-niceng234er2-lrg.png" alt="Cover of Evidence review for service configuration and delivery (management and rehabilitation)" /></a></div><div class="bkr_bib"><h1 id="_NBK595815_"><span itemprop="name">Evidence review for service configuration and delivery (management and rehabilitation)</span></h1><div class="subtitle">Spinal metastases and metastatic spinal cord compression</div><p><b>Evidence review B</b></p><p><i>NICE Guideline, No. 234</i></p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2023 Sep</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-5312-7</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2023.</div></div><div class="bkr_clear"></div></div><div id="niceng234er2.s1"><h2 id="_niceng234er2_s1_">Service configuration and delivery (management and rehabilitation)</h2><div id="niceng234er2.s1.1"><h3>Review question</h3><p>What service configuration and delivery arrangements are effective in the management and early rehabilitation of adults with suspected or confirmed spinal metastases, direct malignant infiltration of the spine or associated spinal cord compression?</p><div id="niceng234er2.s1.1.1"><h4>Introduction</h4><p>The management and early rehabilitation of adults with suspected or confirmed spinal metastases, direct malignant infiltration of the spine or associated spinal cord compression requires coordination between various specialties including primary care, haematology, oncology, palliative care, physiotherapy, radiology, and spinal surgery. This review aims to summarise the effectiveness of different service delivery models for the care and early rehabilitation of people with malignant spinal cord compression or spinal metastases.</p></div><div id="niceng234er2.s1.1.2"><h4>Summary of the protocol</h4><p>See <a class="figpopup" href="/books/NBK595815/table/niceng234er2.tab1/?report=objectonly" target="object" rid-figpopup="figniceng234er2tab1" rid-ob="figobniceng234er2tab1">Table 1</a> for a summary of the Population, Intervention, Comparison and Outcome (PICO) characteristics of this review.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng234er2tab1"><a href="/books/NBK595815/table/niceng234er2.tab1/?report=objectonly" target="object" title="Table 1" class="img_link icnblk_img figpopup" rid-figpopup="figniceng234er2tab1" rid-ob="figobniceng234er2tab1"><img class="small-thumb" src="/books/NBK595815/table/niceng234er2.tab1/?report=thumb" src-large="/books/NBK595815/table/niceng234er2.tab1/?report=previmg" alt="Table 1. Summary of the protocol (PICO table)." /></a><div class="icnblk_cntnt"><h4 id="niceng234er2.tab1"><a href="/books/NBK595815/table/niceng234er2.tab1/?report=objectonly" target="object" rid-ob="figobniceng234er2tab1">Table 1</a></h4><p class="float-caption no_bottom_margin">Summary of the protocol (PICO table). </p></div></div><p>For further details see the review protocol in <a href="#niceng234er2.appa">appendix A</a>.</p></div><div id="niceng234er2.s1.1.3"><h4>Methods and process</h4><p>This evidence review was developed using the methods and process described in <a href="https://www.nice.org.uk/process/pmg20/chapter/introduction" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>. Methods specific to this review question are described in the review protocol in <a href="#niceng234er2.appa">appendix A</a> and the <a href="/books/NBK595815/bin/NG234_Supp_1_Methods_pdf.pdf">methods</a> document (supplementary document 1).</p><p>The NICE methods and process manual emphasises the value of real-world data, setting out best practices in the <a href="https://www.nice.org.uk/about/what-we-do/real-world-evidence-framework" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NICE Real world evidence framework</a>. As part of this approach an audit dataset from the MSCC service at the UK Clatterbridge Cancer Centre was analysed specifically for this review question and the associated health economic model (<a href="#niceng234er2.appi">Appendix I</a>). This is an audit of all people referred to an MSCC service between January 2018 until end of May 2022 covering a population of 2.4 million people across Cheshire, Merseyside, and the surrounding areas. The impact of changes to the MSCC service configuration on overall survival (adjusted for age and sex) was calculated for the group as a whole as well as for different primary cancers and according to deprivation quintile.</p><p>This was a minor deviation from the protocol which stated that service evaluations and audits would only be included in the in the absence of comparative randomised or non-randomised studies. The Clatterbridge Cancer Centre data, however, provided up-to-date data from a UK setting, something that was lacking the included published studies.</p><p>Declarations of interest were recorded according to <a href="https://www.nice.org.uk/about/who-we-are/policies-and-procedures" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NICE’s conflicts of interest policy</a>.</p></div><div id="niceng234er2.s1.1.4"><h4>Effectiveness evidence</h4><div id="niceng234er2.s1.1.4.1"><h5>Included studies</h5><p>Four published studies were included in this review (<a class="bibr" href="#niceng234er2.s1.ref2" rid="niceng234er2.s1.ref2">Cui 2021</a>, <a class="bibr" href="#niceng234er2.s1.ref3" rid="niceng234er2.s1.ref3">Fitzpatrick 2012</a>, <a class="bibr" href="#niceng234er2.s1.ref4" rid="niceng234er2.s1.ref4">Guddati 2017</a>, <a class="bibr" href="#niceng234er2.s1.ref5" rid="niceng234er2.s1.ref5">Malik 2020</a>) plus one analysis specifically conducted for this guideline using an audit of all people referred to an MSCC service between January 2018 until end of May 2022 in the UK Clatterbridge Cancer Centre regional MSCC service (covering a population of 2.4 million people across Cheshire, Merseyside, and the surrounding areas) – referred to from hereon in as <a class="bibr" href="#niceng234er2.s1.ref1" rid="niceng234er2.s1.ref1">Clatterbridge 2022</a>. See also the de novo economic model based on this audit in <a href="#niceng234er2.appi">appendix I</a>.</p><p>Three were retrospective (<a class="bibr" href="#niceng234er2.s1.ref2" rid="niceng234er2.s1.ref2">Cui 2021</a>, <a class="bibr" href="#niceng234er2.s1.ref4" rid="niceng234er2.s1.ref4">Guddati 2017</a> and <a class="bibr" href="#niceng234er2.s1.ref5" rid="niceng234er2.s1.ref5">Malik 2020</a>) and 2 were prospective (<a class="bibr" href="#niceng234er2.s1.ref1" rid="niceng234er2.s1.ref1">Clatterbridge 2022</a>, <a class="bibr" href="#niceng234er2.s1.ref3" rid="niceng234er2.s1.ref3">Fitzpatrick 2012</a>).</p><p>One study was conducted in the UK (<a class="bibr" href="#niceng234er2.s1.ref1" rid="niceng234er2.s1.ref1">Clatterbridge 2022</a>), 2 in the United States (<a class="bibr" href="#niceng234er2.s1.ref4" rid="niceng234er2.s1.ref4">Guddati 2017</a> and <a class="bibr" href="#niceng234er2.s1.ref5" rid="niceng234er2.s1.ref5">Malik 2020</a>), 1 in Canada (<a class="bibr" href="#niceng234er2.s1.ref3" rid="niceng234er2.s1.ref3">Fitzpatrick 2012</a>), and 1 study in China (<a class="bibr" href="#niceng234er2.s1.ref2" rid="niceng234er2.s1.ref2">Cui 2021</a>).</p><p>The included studies are summarised in <a class="figpopup" href="/books/NBK595815/table/niceng234er2.tab2/?report=objectonly" target="object" rid-figpopup="figniceng234er2tab2" rid-ob="figobniceng234er2tab2">Table 2</a>.</p><p>One study (<a class="bibr" href="#niceng234er2.s1.ref1" rid="niceng234er2.s1.ref1">Clatterbridge 2022</a>) compared outcomes before and after an MSCC service configuration change. One study compared surgery being done within 3 days, between 4 and 7 days or after 7 days after the onset of symptoms (<a class="bibr" href="#niceng234er2.s1.ref2" rid="niceng234er2.s1.ref2">Cui 2021</a>), another study compared virtual consultation between oncologists and spinal surgeons to no virtual consultation (<a class="bibr" href="#niceng234er2.s1.ref3" rid="niceng234er2.s1.ref3">Fitzpatrick 2012</a>). One study compared early to late intervention (before or after 48 hours of hospitalization) with radiotherapy or surgery (<a class="bibr" href="#niceng234er2.s1.ref4" rid="niceng234er2.s1.ref4">Guddati 2017</a>) and 1 study compared spinal metastasis surgery by orthopaedic surgeons or neurosurgeons on patient outcomes (<a class="bibr" href="#niceng234er2.s1.ref5" rid="niceng234er2.s1.ref5">Malik 2020</a>).</p><p>See also the related evidence review of service configuration related to investigations and referral (evidence review A).</p><p>See the literature search strategy in <a href="#niceng234er2.appb">appendix B</a> and study selection flow chart in <a href="#niceng234er2.appc">appendix C</a>.</p></div><div id="niceng234er2.s1.1.4.2"><h5>Excluded studies</h5><p>Studies not included in this review are listed, and reasons for their exclusion are provided in <a href="#niceng234er2.appk">appendix K</a>.</p></div></div><div id="niceng234er2.s1.1.5"><h4>Summary of studies included in the evidence review</h4><p>Summaries of the studies that were included in this review are presented in <a class="figpopup" href="/books/NBK595815/table/niceng234er2.tab2/?report=objectonly" target="object" rid-figpopup="figniceng234er2tab2" rid-ob="figobniceng234er2tab2">Table 2</a>.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng234er2tab2"><a href="/books/NBK595815/table/niceng234er2.tab2/?report=objectonly" target="object" title="Table 2" class="img_link icnblk_img figpopup" rid-figpopup="figniceng234er2tab2" rid-ob="figobniceng234er2tab2"><img class="small-thumb" src="/books/NBK595815/table/niceng234er2.tab2/?report=thumb" src-large="/books/NBK595815/table/niceng234er2.tab2/?report=previmg" alt="Table 2. Summary of included studies." /></a><div class="icnblk_cntnt"><h4 id="niceng234er2.tab2"><a href="/books/NBK595815/table/niceng234er2.tab2/?report=objectonly" target="object" rid-ob="figobniceng234er2tab2">Table 2</a></h4><p class="float-caption no_bottom_margin">Summary of included studies. </p></div></div><p>See the full evidence tables in <a href="#niceng234er2.appd">appendix D</a>. No meta-analysis was conducted (and so there are no forest plots in <a href="#niceng234er2.appe">appendix E</a>).</p></div><div id="niceng234er2.s1.1.6"><h4>Summary of the evidence</h4><p>There was very low quality evidence of an important benefit in terms of overall survival for people with lung, unknown primary or other (non-prostate or breast) cancers following upskilling of the staff in an MSCC service to act as MSCC coordinators and make initial clinical decisions on referrals into the service. There was no important difference for patients with prostate or breast cancer, however.</p><p>One study provided low to moderate quality evidence of an important benefit with earlier intervention in terms of in hospital mortality and length of hospital stay. Very low quality evidence from another study indicated important benefit in terms of hospital stay with earlier intervention, but no evidence of difference for neurological and functional status outcomes.</p><p>There was no evidence of important difference when comparing virtual consultation between spinal surgeons and oncologists with no virtual consultation as a way to identify people with MSCC candidates for surgery. This evidence was of low quality.</p><p>There was very low quality evidence of no important difference in outcomes of surgery for spinal metastases carried out by neurosurgeons and by orthopaedic surgeons.</p><p>See the evidence profiles in <a href="#niceng234er2.appf">appendix F</a>.</p></div><div id="niceng234er2.s1.1.7"><h4>Economic evidence</h4><div id="niceng234er2.s1.1.7.1"><h5>Included studies</h5><p>A systematic review of the economic literature was conducted but no economic studies were identified which were applicable to this review question.</p><p>A single <a href="/books/NBK595815/bin/NG234_Supp_2_Health_economics_pdf.pdf">economic</a> search was undertaken for all topics included in the scope of this guideline. See supplement 2 for details.</p></div><div id="niceng234er2.s1.1.7.2"><h5>Excluded studies</h5><p><a href="/books/NBK595815/bin/NG234_Supp_2_Health_economics_pdf.pdf">Economic</a> studies not included in this review are listed, and reasons for their exclusion are provided in supplement 2.</p></div></div><div id="niceng234er2.s1.1.8"><h4>Summary of included economic evidence</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng234er2tab3"><a href="/books/NBK595815/table/niceng234er2.tab3/?report=objectonly" target="object" title="Table 3" class="img_link icnblk_img figpopup" rid-figpopup="figniceng234er2tab3" rid-ob="figobniceng234er2tab3"><img class="small-thumb" src="/books/NBK595815/table/niceng234er2.tab3/?report=thumb" src-large="/books/NBK595815/table/niceng234er2.tab3/?report=previmg" alt="Table 3. Economic evidence profile of an economic evaluation of the addition of radiotherapy for people undergoing surgery for metastatic spinal cord compression." /></a><div class="icnblk_cntnt"><h4 id="niceng234er2.tab3"><a href="/books/NBK595815/table/niceng234er2.tab3/?report=objectonly" target="object" rid-ob="figobniceng234er2tab3">Table 3</a></h4><p class="float-caption no_bottom_margin">Economic evidence profile of an economic evaluation of the addition of radiotherapy for people undergoing surgery for metastatic spinal cord compression. </p></div></div></div><div id="niceng234er2.s1.1.9"><h4>Economic model</h4><p>An economic model was developed for this topic looking at the cost effectiveness of upskilling team members to undertake the MSCC coordinator role which would enable them to make initial clinical decisions around referrals to 1 regional MSCC centre. The full economic model is reported in <a href="#niceng234er2.appi">appendix I</a>.</p><p>The economic model was based on audit data, covering the period from January 2018 to May 2022 from 1 regional MSCC service. The MSCC service was set-up in January 2017 with the full launch of the pathway in January 2018 reflecting recommendations made in the previous guideline around coordinated pathways for MSCC and having one point of contact for suspected MSCC and spinal metastases.</p><p>A before and after study design was used to look retrospectively at differences in survival, QALYs and costs following upskilling of team members to be able to undertake the MSCC coordinator role. The model was also designed to look at trends in survival and costs since the launch of the service to make inferences about improvements over time. The model also used English Indices of Multiple Deprivation to investigate whether these outcomes differed by socio-economic status.</p><p>The economic analysis found that there was benefit in terms of improving outcomes and reducing costs from upskilling staff although these benefits were not evenly distributed across all deprivation groups with the largest benefits coming in the second and third least deprived quintiles. The analysis also highlighted an increase in survival over time since the creation of the regional MSCC service.</p><p>There were a number of weaknesses with the economic model. It was not possible to control for all confounding factors in the before and after group that could have resulted in differences between outcomes, so it was difficult to assign all changes in the difference between groups to the upskilling intervention. There were also difficulties in estimating all potential costs and QALYs for the two groups.</p></div><div id="niceng234er2.s1.1.10"><h4>Evidence Statement</h4><p>NICE 2023 was a cost utility analysis, developed to inform this evidence review, reporting outcomes in terms of cost per QALY gained from upskilling team members to undertake the MSCC coordinator role.</p><p>The study found the upskilling of team members to be cost saving and health improving. These results were robust to sensitivity analysis although subgroup analysis found that the most and least deprived groups did not benefit as much from the intervention with the majority of the benefit being in the second and third least deprived quintiles. The study was deemed to be directly applicable to the review question with potentially serious methodological limitations.</p></div><div id="niceng234er2.s1.1.11"><h4>The committee’s discussion and interpretation of the evidence</h4><div id="niceng234er2.s1.1.11.1"><h5>The outcomes that matter most</h5><p>Overall survival, quality of life, patient satisfaction and neurological and functional status were chosen as critical outcomes. This is because efficient referral and care pathways should lead to quicker diagnosis and treatment of metastatic spinal disease leading to better patient outcomes. Emergency admission to hospital and length of stay were important outcomes because an inefficient or delayed referral pathway could increase emergency hospital admissions and result in longer hospital stays. Access to services was chosen as an important outcome to capture service availability in terms of geographic location and waiting times for services. Different configurations (for example centralised versus local) mean that patients may have to travel or wait longer for services.</p></div><div id="niceng234er2.s1.1.11.2"><h5>The quality of the evidence</h5><p>The quality of the evidence was assessed using GRADE and all outcomes were rated as low to very low quality. This was predominately due to a very serious overall risk of bias in the evidence contributing to the outcomes, and serious levels of imprecision in the effect estimates. Due to the design of the included studies, it was difficult to avoid confounding between the different intervention groups (for example patients receiving early interventions might be different from those receiving delayed intervention in these studies because a delay in receiving interventions is not an option for some patients in need of urgent care). As a result, the committee also used their expertise and experience when making recommendations.</p><p>No evidence was identified for the outcomes quality of life, pain and waiting times.</p></div><div id="niceng234er2.s1.1.11.3"><h5>Benefits and harms</h5><p>The committee discussed that the previous guideline set service configuration standards for care with some detailed recommendations about how they should function. The guideline also led to a NICE quality standard for MSCC which featured service configuration as an important driver for improvements in MSCC care with 1 of the standards relating to supportive care and rehabilitation (statements <a href="https://www.nice.org.uk/guidance/qs56/chapter/Quality-statement-7-Supportive-care-and-rehabilitation" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">7</a> - <a href="https://www.nice.org.uk/guidance/qs56/chapter/Quality-statement-5-Coordinating-care-for-adults-with-metastatic-spinal-cord-compression" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Metastatic spinal cord compression in adults – QS56</a>). The committee agreed that the previous guideline’s standards ought to be maintained and improved upon where variation still exists. They therefore used the previous guideline’s recommendations as a starting point for their discussion.</p><p>They also discussed the Clatterbridge Cancer Centre regional MSCC service which provided audit data to inform the bespoke analysis and economic model. The outcomes from that analysis were uncertain, due to the nature of such data making it difficult to control for all potential confounders. The outcomes from the analysis were therefore assessed as low quality, however the committee agreed that the audit was directly applicable to the UK context and provided a complete dataset of all individuals referred to 1 UK MSCC centre. The committee gave this analysis more weight than other evidence in their discussion because it reflected current best practice based on the previous guideline’s recommendations and the evidence suggested an increase in overall survival since the implementation of the service.</p></div><div id="niceng234er2.s1.1.11.4"><h5>Cancer alliances and commissioners</h5><p>The evidence on clinical care pathways was inconclusive; however, the committee agreed, based on their own experience, to draft a recommendation emphasising the value of these as a means of improving access to services for people with spinal metastases, direct malignant infiltration of the spine and metastatic spinal cord compression. They discussed the analysis of the Clatterbridge Cancer Centre regional MSCC service audit (which adopted the NICE 2008 guideline including recommendations on how cancer alliances should function) and noted that it showed steady improvement in length of survival over time. This was consistent with the committee’s experience of the positive impact that the previous guideline had, particularly in the area of service configuration. Based on the evidence and their experience the committee decided to recommend that service commissioners working with their cancer alliances should ensure that appropriate services covering all parts of the pathway, for example, diagnosis, early rehabilitation, etc, are commissioned to enable any implemented pathway to function effectively and efficiently. A pathway would be a means by which people with the condition and healthcare professionals from all settings can navigate the care they receive and people know what to expect. This is particularly important for MSCC services because of the many different specialties that are involved in care. The committee noted the importance of service review and agreed to recommend that cancer alliances regularly monitor their services to ensure that they are suitable and meet any targets or quality standards (such as the timing around MRI assessments). Monitoring this by the means of prospective audit allows conclusions to be drawn about what works well and what could be improved to make services work better and improve outcomes.</p><p>Based on their experience of current practice and services, the committee agreed that cancer alliances work most effectively when there is good organisational and clinical leadership, with clearly defined responsibilities. They therefore agreed to recommend that each cancer alliance appoints a lead who provides oversight and chairs the steering committee. This would include advising the cancer alliance about the organisation of services on behalf of the steering group because any changes could have an impact on the whole cancer alliance. The committee also agreed that reviewing the implementation of care pathways is an important responsibility so that any gaps in implementation can be identified and escalated if necessary. Monitoring services would also be an important part of the role so that any improvements are recognised and concerns can be raised where necessary. There is also the organisational aspect of chairing and arranging the meetings of the steering group which would be a part of their responsibilities so that meetings run smoothly and all necessary issues are raised and discussed.</p><p>The committee also emphasised the importance of joint working and coordination within the cancer alliance itself and agreed to recommend that each service forming part of the alliance should identify a lead healthcare professional for metastatic spinal cord compression who provides oversight of the clinical care pathway at a local level and is a member of the steering committee. They listed some of the role’s responsibilities. The committee agreed that they should represent the setting that they are based in to ensure that the steering group knows what works best or where there are concerns taking into account all perspectives. Each service lead should also disseminate the decisions made about the care pathway so that they are implemented locally. They would also liaise with other healthcare professionals involved in the pathway so effective and timely communication is needed to ensure people work collaboratively and constructively together to meet people’s needs. Another important responsibility is that they make sure that the healthcare professionals within their service are aware of the treatments that are being used and that they understand them as this would make it easier for everyone to know which treatment the person may require and why. The committee discussed the importance of data collection to learn lessons about what worked well and where there may be concerns which would help improve services. They decided to recommend that lead healthcare professionals should contribute to regular audits so that outcomes could be measured so that positive or negative changes can be identified. Attending steering group meetings would also be within the role’s remit so that they can raise any issues that may have arisen in their locality and contribute to the overall aims of the steering group.</p><p>Based on their experience and knowledge of what works well in current services, including in the Clatterbridge Cancer Centre regional MSCC service which is based on the previous NICE guideline’s service configuration standards and showed steady improvement in survival times, the committee also agreed to recommend that each cancer alliance should have a steering group for metastatic spinal cord compression to oversee service to ensure that care pathways and commissioned services meet people’s needs. The committee agreed that input from people with lived experience of metastatic spinal cord compression would be especially important in this regard. They discussed that user input could also be an important way to highlight concerns that people may have and identify potential inequalities in service provision and access to services. It is also important that there is representation from healthcare professionals from all care settings and relevant specialties (for instance alliance groups for primary tumours) as well as representation from the MSCC service in these steering groups. This would mean that all perspectives are taken into account to help implement care pathways effectively and ensure they meet people’s needs. It would also mean that there is full accountability from the MSCC service to the steering group and up to alliance level.</p></div><div id="niceng234er2.s1.1.11.5"><h5>Providing a coordinated MSCC service</h5><p>The committee noted, based on experience, that communication and coordination between specialist and community-based services can often be difficult, particularly in relation to discharge from hospital and care continuity. This can have a detrimental impact on patient outcomes. To address these difficulties the committee agreed to recommend that each metastatic spinal cord compression service should work to establish effective links with relevant services in the community such as primary care, social services, and palliative care. This would mean that information is shared between services which prevents the frustration of people being discharged having to provide the details themselves to every different service that they may have contact with post discharge. It may also prevent important information being missed. The committee discussed that this is consistent with the last NICE guideline’s recommendation and has been an important part of the service of the Clatterbridge Cancer Centre regional MSCC service which coordinates care based on the principle of that guideline and has shown steady improvement in length of survival.</p><p>The committee discussed the importance of data collection and audit processes (such as the Clatterbridge Cancer Centre regional MSCC service audit), noting that some services were more proactive in this regard than others. They agreed that comprehensive and well-run audits are an essential step in ensuring that services are appropriate and effective and meet people’s needs. They agreed to recommend that metastatic spinal cord compression services put systems and processes in place to record data and investigate and report incidents so barriers and facilitators to effective services and improved outcomes can be identified.</p></div><div id="niceng234er2.s1.1.11.6"><h5>Providing support and rehabilitation services</h5><p>No evidence was identified in relation to services around early rehabilitation. The committee agreed that whilst the recommendations from the previous guideline were still relevant, they should be updated to better reflect current practice.</p><p>The committee discussed that there is variation in discharge planning and that this results in people staying longer in hospital than needed and that is not only detrimental to the person’s quality of life but also costly. They emphasised that community-based nursing and rehabilitation services and access to equipment and support from social services are an essential component of care for people with suspected or confirmed spinal metastases, direct malignant infiltration of the spine, or metastatic spinal cord compression to make discharge to home possible without delay. They therefore agreed to recommend that commissioners and local authorities should work together to arrange these services so that people can safely return home.</p><p>The previous guideline had recommended that care in a specialist rehabilitation unit should be offered to people with spinal metastases, direct malignant of the spine, or metastatic spinal cord compression. Whilst the committee agreed that specialist rehabilitation may some-times be needed, they agreed that this did not routinely need to take place on an inpatient basis. They noted that services have evolved to make some of rehabilitation previously only provided in a specialist unit possible in the community. They therefore agreed that it would not lower standards set by the previous guideline to not make the recommendation that rehabilitation should routinely be provided in units. The committee also agreed that decisions about who should be offered specialist rehabilitation are dependent on a range of factors such as level of function, treatment, and the benefit the person is likely to get from such care. The committee recognised that they could not be prescriptive in regard to this recommendation on who might be defined as specifically benefitting from specialist rehabilitation and agreed that it was appropriate to leave this to clinical judgement.</p><p>The committee also discussed the importance of discharge planning and agreed upon the importance of coordination. As a result, the committee agreed to recommend that a named individual from the responsible clinical team leads the process. They noted that this was one of the principles promoted in the previous NICE guideline and implemented in the Clatterbridge Cancer Centre regional MSCC service. To enable safe discharge the named individual (which may or may not be the MSCC coordinator) would have to liaise with all relevant people that would enable people to return home, such as the person and their family or carers. This means that their wishes and concerns can be taken into account. They discussed that the named individual would also need to liaise with the primary oncology team in order to arrange follow-up treatment or review where necessary, the rehabilitation team to help mobilise the person or provide support to reach other rehabilitation goals as well as working collaboratively with other community healthcare support services for instance primary care service, to ensure that relevant information is shared and if necessary make arrangements with palliative care to provide medical and other support to the person who may be approaching the end of life.</p><p>They acknowledged that there are other NICE guidelines that are relevant to support safe discharge from hospital and decided to raise awareness that these are also appropriate for this guideline’s context, in relation to support and training that is needed, hospital discharge planning and other rehabilitation principles and so they signposted to them (see the ‘other factors the committee took into account’ section below for links to these guidelines).</p></div><div id="niceng234er2.s1.1.11.7"><h5>Rehabilitation and supportive care</h5><p>The committee discussed that rehabilitation needs are not only addressed by service configuration so they agreed that some high-level clinical rehabilitation principles should be highlighted despite there not being a clinical review of rehabilitation as a topic in the scope for this guideline. Whilst it is not strictly service organisation, they decided that services need to adopt those principles so that safe discharge is timely and safe. They also noted that there is a lot of other NICE guidance available that is relevant to this topic and wanted to raise awareness that these also apply to the condition addressed by this guideline (see the ‘other factors the committee took into account’ section for details of the related guidelines).</p><p>One of these principles ‘is that rehabilitation does not only start at the end of a person’s hospital stay but should be taken into account from diagnosis onwards so that the relevant specialties can be involved throughout the person’s pathway to support them with the management plan and help them to achieve their goals. They highlighted that the NICE guideline on <a href="https://www.nice.org.uk/guidance/ng211/chapter/Recommendations#commissioning-and-organisation-of-rehabilitation-services" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">rehabilitation after traumatic injury</a> contains a whole section on setting goals with the person so that rehabilitation can be tailored to the person’s wishes and preferences. They provided 3 examples of what these goals may be which related to the person’s autonomy (in way of function and activities of daily living) and improving quality of life.</p><p>They also agreed, based on their own experience, that currently there is variation in practice in when in the care pathway discharge planning is considered which can result in delay if planning is started late. To address this, they agreed that discharge planning works best when it is initiated at the point of admission to hospital so that rehabilitation needs are reviewed throughout and all services and support are in place to make discharge possible in a timely manner.</p><p>With MSCC being associated with serious neurological sequalae it is essential that people receive specialist rehabilitation where needed, so that they can maintain or regain function. Whilst this can be costly and resource intensive the committee discussed that it will save money because where possible people can return home and live independently which improves quality of life and reduces resource use such as longer hospital stays. They therefore decided that this should be routinely offered.</p><p>They noted that there are many clinical issues that may be relevant during rehabilitation and supportive care ranging from risk of venous thromboembolisms when being immobilised, developing pressure ulcers during hospital admission, fecal and urinary incontinence as a result of the neurological impact of MSCC and other clinical matters. They therefore signposted to the relevant NICE guidance so that this can be followed to address these clinical matters (see the ‘other factors the committee took into account’ section below).</p></div><div id="niceng234er2.s1.1.11.8"><h5>How the recommendations might affect services</h5><p>The committee acknowledged that many MSCC services currently only accept referrals for suspected or confirmed MSCC but not for people with spinal metastases without MSCC. This means that the new recommendations will increase activities significantly. The committee discussed that MSCC services should have spinal oversight and bring together the relevant critical expertise which would have clinical and survival benefits. The evidence from the economic model based on a service that was already set up and providing full spinal oversight showed that once implemented it resulted in cost savings because it prevented people losing function and maintained their independence. This was confirmed by the economic analysis, which showed that costs decreased per person after the creation of the service and therefore it could be inferred that implementation costs should be regained over the first few years of a newly set up service. The committee noted that many services already provide advice on the treatment of spinal metastases or suspected MSCC so relevant experience already exists that would help implement this.</p></div><div id="niceng234er2.s1.1.11.9"><h5>Cost effectiveness and resource use</h5><p>The committee considered the before and after study and economic evaluation developed for this evidence report. The model looked at the cost effectiveness of upskilling staff to make decisions around decisions around less complex cases in line with the role of the MSCC coordinator. This was a refinement to the implementation of the MSCC service model as recommended by the previous NICE guideline which was the ‘before’ state in the ‘before and after’ audit analysis and economic model. The economic model found that doing so improved overall survival, increased QALYs and reduced cost. The committee acknowledged the weaknesses in the economic model but were confident that cost savings and health improvements were likely from the intervention and ongoing improvements within the service, for example basing it in the oncology team which made collaboration with other specialties more efficient (see also evidence review A). They also highlighted that health outcomes had improved year on year since the creation of the regional MSCC service.</p><p>Whilst the committee did not explicitly make recommendations around upskilling staff, they believed it highlighted the need to have clear pathways. Clear pathways allow for the appropriate staff to quickly make a diagnosis and plan treatment for patients and lead to optimal intervention. The committee believed it was unlikely that the increased benefits and reduced costs per person, estimated by the economic model, would be achieved without such pathways in place. The committee also highlighted that the audit data used in the model had a first observation after the launch of the MSCC regional service and that survival improved and cost savings got larger over the course of the time horizon of the model. The committee used this evidence to infer that improvements had in part been achieved from the launch of this service and used the operating model of the Clatterbridge Cancer Centre regional MSCC service to inform recommendations around setting up services. These included recommendations around pathways, having a lead healthcare professional and an alliance lead, clear auditing and commissioning a steering group including people with lived experience.</p><p>For areas where such a regional centre is not already formed there will be large costs from setting this up through recruiting members of panels, setting up computer systems for recording patient information, auditing outcomes and for forming and disseminating pathways and training staff. Whilst the economic model considered the strengthening of an existing MSCC service rather than the creation a new one, the implementation of new centres is likely to encounter similar costs including from the training of staff to undertake the role. As cost savings increased since the introduction over the time horizon of the economic model the committee thought these one-off costs would be fully recouped over the first few years of the service operating. No recommendations were made about what training should cover because that is the remit of the various professional organisations to determine.</p><p>Discharge planning at the point of admission to hospital should lead to less delays in discharge, reducing the number of bed days in hospital for people and freeing up health care professionals. Whilst there may need to be some reconfiguration so this task is undertaken earlier, as it needs to be performed anyway, there should be no initial increase in resource use.</p><p>There will be an initial resource impact with recommendations around specialist rehabilitation with this not always being received by people needing it. Despite not identifying any economic evidence around this the committee highlighted it was consistent with previous NICE guidelines. Given the potential for catastrophic events such as paraplegia and that specialist rehabilitation will be the most likely pathway for these people to return home and live independently, there will be cost savings through reduced need for community care at later times and through avoidance of the costs associated with adverse events.</p></div><div id="niceng234er2.s1.1.11.10"><h5>Other factors the committee took into account</h5><p>The committee noted that there are a range of NICE guidelines relevant to the topic of support and rehabilitation after discharge and agreed to reference these in the recommendations. These included <a href="https://www.nice.org.uk/guidance/ng211/chapter/Recommendations#commissioning-and-organisation-of-rehabilitation-services" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">rehabilitation after traumatic injury</a>, <a href="https://www.nice.org.uk/guidance/ng89" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">venous thromboembolism in over</a>
|
|
<a href="https://www.nice.org.uk/guidance/ng89" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">16s</a>, <a href="https://www.nice.org.uk/guidance/cg179" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">prevention and management of pressure ulcers</a>, <a href="https://www.nice.org.uk/guidance/cg148" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">urinary incontinence due to neurological conditions</a> and <a href="https://www.nice.org.uk/guidance/cg49" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">fecal incontinence in adults</a>.</p></div></div><div id="niceng234er2.s1.1.12"><h4>Recommendations supported by this evidence review</h4><p>This evidence review supports recommendations 1.1.1 to 1.1.4, 1.1.11, 1.1.12, 1.1.22 to 1.1.28 and 1.12.1 to 1.12.5 in the NICE guideline.</p></div></div><div id="niceng234er2.s1.rl.r1"><h3>References – included studies</h3><ul class="simple-list"><div id="niceng234er2.s1.rl.r1.1"><h4>Effectiveness</h4><ul class="simple-list"><li class="half_rhythm"><p><div class="bk_ref" id="niceng234er2.s1.ref1"><p id="p-189">
|
|
<strong>Clatterbridge 2022</strong>
|
|
</p>Clatterbridge Cancer Centre. Upskilling staff in MSCC coordination to make initial decisions around referrals to a metastatic spinal cord compression service without senior clinician support. A ‘before and after’ study from one UK centre. [<em>Unpublished audit</em>]; 2022 see appendix I.</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng234er2.s1.ref2"><p id="p-190">
|
|
<strong>Cui 2021</strong>
|
|
</p>Cui
|
|
Y, Shi
|
|
X, Li
|
|
C, et al. Effect of the Timing of Surgery on Neurological Recovery for Patients with Incomplete Paraplegia Caused by Metastatic Spinal Cord Compression. Therapeutics and Clinical Risk Management
|
|
17, 831–40, 2021 [<a href="/pmc/articles/PMC8370494/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8370494</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/34413649" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34413649</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng234er2.s1.ref3"><p id="p-191">
|
|
<strong>Fitzpatrick 2012</strong>
|
|
</p>Fitzpatrick
|
|
D, Grabarz
|
|
D, Wang
|
|
L, et al. How effective is a virtual consultation process in facilitating multidisciplinary decision-making for malignant epidural spinal cord compression?
|
|
International Journal of Radiation Oncology, Biology, Physics
|
|
84, e167–72, 2012 [<a href="https://pubmed.ncbi.nlm.nih.gov/22682804" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22682804</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng234er2.s1.ref4"><p id="p-192">
|
|
<strong>Guddati 2017</strong>
|
|
</p>Guddati
|
|
A, Kumar
|
|
K, Shapira
|
|
I. Early intervention results in lower mortality in patients with cancer hospitalized for metastatic spinal cord compression. Journal of Investigative Medicine, 65, 787–793, 2017 [<a href="https://pubmed.ncbi.nlm.nih.gov/28138012" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28138012</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng234er2.s1.ref5"><p id="p-193">
|
|
<strong>Malik 2020</strong>
|
|
</p>Malik
|
|
A, Baek
|
|
J, Alexander
|
|
J, et al. Orthopaedic vs. Neurosurgery – Does a surgeon’s specialty have an influence on 90-day complications following surgical intervention of spinal metastases?
|
|
Clinical Neurology and Neurosurgery
|
|
192, 105735, 2020 [<a href="https://pubmed.ncbi.nlm.nih.gov/32078956" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32078956</span></a>]</div></p></li></ul></div></ul></div></div><div id="appendixesappgroup1"><h2 id="_appendixesappgroup1_">Appendices</h2><div id="niceng234er2.appa"><h3>Appendix A. Review protocols</h3><p id="niceng234er2.appa.et1"><a href="/books/NBK595815/bin/niceng234er2-appa-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Review protocol for review question: What service configuration and delivery arrangements are effective in the management and early rehabilitation of adults with suspected or confirmed spinal metastases, direct malignant infiltration of the spine or associated spinal cord compression?</a><span class="small"> (PDF, 208K)</span></p></div><div id="niceng234er2.appb"><h3>Appendix B. Search strategy (clinical/economic)</h3><p id="niceng234er2.appb.et1"><a href="/books/NBK595815/bin/niceng234er2-appb-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Literature search strategies for review question: What service configuration and delivery arrangements are effective in the management and early rehabilitation of adults with suspected or confirmed spinal metastases, direct malignant infiltration of the spine or associated spinal cord compression?</a><span class="small"> (PDF, 126K)</span></p></div><div id="niceng234er2.appc"><h3>Appendix C. Effectiveness evidence study selection</h3><p id="niceng234er2.appc.et1"><a href="/books/NBK595815/bin/niceng234er2-appc-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Study selection for: What service configuration and delivery arrangements are effective in the management and early rehabilitation of adults with suspected or confirmed spinal metastases, direct malignant infiltration of the spine or associated spinal cord compression?</a><span class="small"> (PDF, 95K)</span></p></div><div id="niceng234er2.appd"><h3>Appendix D. Evidence tables</h3><p id="niceng234er2.appd.et1"><a href="/books/NBK595815/bin/niceng234er2-appd-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Evidence tables for review question: What service configuration and delivery arrangements are effective in the management and early rehabilitation of adults with suspected or confirmed spinal metastases, direct malignant infiltration of the spine or associated spinal cord compression?</a><span class="small"> (PDF, 279K)</span></p></div><div id="niceng234er2.appe"><h3>Appendix E. Forest plots</h3><div id="niceng234er2.appe.s1"><h4>Forest plots for review question: What service configuration and delivery arrangements are effective in the management and early rehabilitation of adults with suspected or confirmed spinal metastases, direct malignant infiltration of the spine or associated spinal cord compression?</h4><p>No meta-analysis was conducted for this review question and so there are no forest plots.</p></div></div><div id="niceng234er2.appf"><h3>Appendix F. GRADE tables</h3><p id="niceng234er2.appf.et1"><a href="/books/NBK595815/bin/niceng234er2-appf-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">GRADE tables for review question: What service configuration and delivery arrangements are effective in the management and early rehabilitation of adults with suspected or confirmed spinal metastases, direct malignant infiltration of the spine or associated spinal cord compression?</a><span class="small"> (PDF, 227K)</span></p></div><div id="niceng234er2.appg"><h3>Appendix G. Economic evidence study selection</h3><div id="niceng234er2.appg.s1"><h4>Study selection for: What service configuration and delivery arrangements are effective in the management and early rehabilitation of adults with suspected or confirmed spinal metastases, direct malignant infiltration of the spine or associated spinal cord compression?</h4><p>No economic evidence was identified which was applicable to this review question.</p></div></div><div id="niceng234er2.apph"><h3>Appendix H. Economic evidence tables</h3><p id="niceng234er2.apph.et1"><a href="/books/NBK595815/bin/niceng234er2-apph-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Economic evidence tables for review question: What service configuration and delivery arrangements are effective in the management and early rehabilitation of adults with suspected or confirmed spinal metastases, direct malignant infiltration of the spine or associated spinal cord compression?</a><span class="small"> (PDF, 135K)</span></p></div><div id="niceng234er2.appi"><h3>Appendix I. Economic model</h3><p id="niceng234er2.appi.et1"><a href="/books/NBK595815/bin/niceng234er2-appi-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Economic model for review question: What service configuration and delivery arrangements are effective in the management and early rehabilitation of adults with suspected or confirmed spinal metastases, direct malignant infiltration of the spine or associated spinal cord compression?</a><span class="small"> (PDF, 504K)</span></p></div><div id="niceng234er2.appj"><h3>Appendix J. Excluded studies</h3><div id="niceng234er2.appj.s1"><h4>Excluded studies for review question: What service configuration and delivery arrangements are effective in the management and early rehabilitation of adults with suspected or confirmed spinal metastases, direct malignant infiltration of the spine or associated spinal cord compression?</h4></div><div id="niceng234er2.appj.s2"><h4>Excluded effectiveness studies</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng234er2appjtab24"><a href="/books/NBK595815/table/niceng234er2.appj.tab24/?report=objectonly" target="object" title="Table 24" class="img_link icnblk_img figpopup" rid-figpopup="figniceng234er2appjtab24" rid-ob="figobniceng234er2appjtab24"><img class="small-thumb" src="/books/NBK595815/table/niceng234er2.appj.tab24/?report=thumb" src-large="/books/NBK595815/table/niceng234er2.appj.tab24/?report=previmg" alt="Table 24. Excluded studies and reasons for their exclusion." /></a><div class="icnblk_cntnt"><h4 id="niceng234er2.appj.tab24"><a href="/books/NBK595815/table/niceng234er2.appj.tab24/?report=objectonly" target="object" rid-ob="figobniceng234er2appjtab24">Table 24</a></h4><p class="float-caption no_bottom_margin">Excluded studies and reasons for their exclusion. </p></div></div></div><div id="niceng234er2.appj.s3"><h4>Excluded economic studies</h4><p>No economic evidence was identified for this review. See supplement 2 for further information.</p></div></div><div id="niceng234er2.appk"><h3>Appendix K. Research recommendations – full details</h3><div id="niceng234er2.appk.s1"><h4>Research recommendations for review question: What service configuration and delivery arrangements are effective in the management and early rehabilitation of adults with suspected or confirmed spinal metastases, direct malignant infiltration of the spine or associated spinal cord compression?</h4><p>No research recommendations were made for this review question.</p></div></div></div></div><div class="fm-sec"><div><p>Final</p></div><div><p>Evidence reviews underpinning recommendations 1.1.1 to 1.1.4, 1.1.11, 1.1.12, 1.1.22 to 1.1.28 and 1.12.1 to 1.12.5 in the NICE guideline</p><p>This evidence review was developed by NICE</p></div><div><p><b>Disclaimer</b>: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.</p><p>Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.</p><p>NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a>, <a href="http://www.scotland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Government</a>, and <a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland Executive</a>. All NICE guidance is subject to regular review and may be updated or withdrawn.</p></div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2023.</div><div class="small"><span class="label">Bookshelf ID: NBK595815</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/37820021" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">37820021</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobniceng234er2tab1"><div id="niceng234er2.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">Summary of the protocol (PICO table)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK595815/table/niceng234er2.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng234er2.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_niceng234er2.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_niceng234er2.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Adults with confirmed
|
|
<ul><li class="half_rhythm"><div>metastatic spinal disease</div></li><li class="half_rhythm"><div>direct malignant infiltration of the spine</div></li></ul></p>
|
|
<p>Adults with confirmed spinal cord or nerve root compression because of
|
|
<ul><li class="half_rhythm"><div>metastatic spinal disease</div></li><li class="half_rhythm"><div>direct malignant infiltration of the spine</div></li></ul></p>
|
|
</td></tr><tr><th id="hd_b_niceng234er2.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention</th><td headers="hd_b_niceng234er2.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Any practice and service delivery models (approaches, configurations of resources and services) for the management and early rehabilitation of malignant spinal cord compression or spinal metastases. For example:
|
|
<ul><li class="half_rhythm"><div>Delivery arrangements:
|
|
<ul class="circle"><li class="half_rhythm"><div>Who provides care and how the healthcare workforce is managed</div></li><li class="half_rhythm"><div>Where care is provided, for example
|
|
<dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>-</dt><dd><p class="no_top_margin">Specialist centres</p></dd></dl><dl class="bkr_refwrap"><dt>-</dt><dd><p class="no_top_margin">Local hospitals</p></dd></dl><dl class="bkr_refwrap"><dt>-</dt><dd><p class="no_top_margin">Neurorehabilitation units</p></dd></dl><dl class="bkr_refwrap"><dt>-</dt><dd><p class="no_top_margin">Rehab while on oncology ward</p></dd></dl></dl></div></li><li class="half_rhythm"><div>How and when care is delivered, for example -
|
|
<dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>-</dt><dd><p class="no_top_margin">Early rehabilitation</p></dd></dl></dl></div></li></ul></div></li><li class="half_rhythm"><div>Coordination of care and management of care processes:
|
|
<ul class="circle"><li class="half_rhythm"><div>Care pathways</div></li><li class="half_rhythm"><div>Service user management (models responsive to individual needs)</div></li><li class="half_rhythm"><div>Communication / referral between providers, for example -
|
|
<dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>-</dt><dd><p class="no_top_margin">Specialist centres and general physiotherapy (for rehabilitation)</p></dd></dl><dl class="bkr_refwrap"><dt>-</dt><dd><p class="no_top_margin">Physiotherapy/orthotics training by specialist centres for local hospitals</p></dd></dl></dl></div></li><li class="half_rhythm"><div>Multidisciplinary teams</div></li></ul></div></li></ul></td></tr><tr><th id="hd_b_niceng234er2.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison</th><td headers="hd_b_niceng234er2.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Interventions compared with:
|
|
<ul><li class="half_rhythm"><div>Each other</div></li><li class="half_rhythm"><div>Combinations of interventions</div></li></ul></td></tr><tr><th id="hd_b_niceng234er2.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcome</th><td headers="hd_b_niceng234er2.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p><b>Critical</b>
|
|
<ul><li class="half_rhythm"><div>Overall survival</div></li><li class="half_rhythm"><div>Quality of life</div></li><li class="half_rhythm"><div>Pain</div></li><li class="half_rhythm"><div>Neurological and functional status including:
|
|
<ul class="circle"><li class="half_rhythm"><div>Bowel and bladder function</div></li><li class="half_rhythm"><div>Mobility or ambulatory status</div></li></ul></div></li></ul></p>
|
|
<p><b>Important</b>
|
|
<ul><li class="half_rhythm"><div>Emergency admission to hospital and length of hospital stay</div></li><li class="half_rhythm"><div>Access to services:
|
|
<ul class="circle"><li class="half_rhythm"><div>Local availability (for example, time/distance travelled to access services)</div></li><li class="half_rhythm"><div>Waiting times for services</div></li></ul></div></li></ul></p>
|
|
</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng234er2tab2"><div id="niceng234er2.tab2" class="table"><h3><span class="label">Table 2</span><span class="title">Summary of included studies</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK595815/table/niceng234er2.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng234er2.tab2_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng234er2.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_niceng234er2.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><th id="hd_h_niceng234er2.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention</th><th id="hd_h_niceng234er2.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison</th><th id="hd_h_niceng234er2.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th></tr></thead><tbody><tr><td headers="hd_h_niceng234er2.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<a class="bibr" href="#niceng234er2.s1.ref1" rid="niceng234er2.s1.ref1">Clatterbridge 2022</a>
|
|
</p>
|
|
<p>Prospective cohort study</p>
|
|
<p>UK</p>
|
|
</td><td headers="hd_h_niceng234er2.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>N=3173</p>
|
|
<p>People referred to an MSCC service via an MSCC referral pathway</p>
|
|
<p>Age, mean, years (SD): 69 (not reported).</p>
|
|
<p>Sex - male/female: 1884/1289</p>
|
|
</td><td headers="hd_h_niceng234er2.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<u>Before service change</u>
|
|
</p>
|
|
<p>MSCC service organised in accordance with the NICE 2008 guideline</p>
|
|
</td><td headers="hd_h_niceng234er2.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<u>After service change</u>
|
|
</p>
|
|
<p>This was a refinement of the ‘before’ service configuration where members of the MSCC team were upskilled in MSCC coordination (to make initial clinical decisions on referrals into the service)</p>
|
|
</td><td headers="hd_h_niceng234er2.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Overall survival</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_niceng234er2.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<a class="bibr" href="#niceng234er2.s1.ref2" rid="niceng234er2.s1.ref2">Cui 2021</a>
|
|
</p>
|
|
<p>Retrospective cohort study</p>
|
|
<p>China</p>
|
|
</td><td headers="hd_h_niceng234er2.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>N=75</p>
|
|
<p>People with incomplete with incomplete spinal cord injury</p>
|
|
<p>Age, mean, years (SD): Overall age not reported but provided in groups according to timing of surgery:
|
|
<ul><li class="half_rhythm"><div>within 4 days: 60 (4)</div></li><li class="half_rhythm"><div>between 4 and 7 days: 63 (3)</div></li><li class="half_rhythm"><div>after 7 days: 61 (2)</div></li></ul></p>
|
|
<p>Sex – male/female: 19/56</p>
|
|
</td><td headers="hd_h_niceng234er2.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<u>Timing of surgery</u>
|
|
</p>
|
|
<p>Whether surgery was performed within 4 days, between 4 and 7 days or after 7 days after the onset of symptoms</p>
|
|
</td><td headers="hd_h_niceng234er2.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<u>Timing of surgery</u>
|
|
</p>
|
|
<p>Whether surgery was performed within 4 days, between 4 and 7 days or after 7 days after the onset of symptoms</p>
|
|
</td><td headers="hd_h_niceng234er2.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Neurological and functional status
|
|
<ul class="circle"><li class="half_rhythm"><div>improvement in AIS scale grade post-operatively</div></li><li class="half_rhythm"><div>ambulatory status</div></li></ul></div></li><li class="half_rhythm"><div>Length of hospital stay</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_niceng234er2.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<a class="bibr" href="#niceng234er2.s1.ref3" rid="niceng234er2.s1.ref3">Fitzpatrick 2012</a>
|
|
</p>
|
|
<p>Prospective cohort study</p>
|
|
<p>Canada</p>
|
|
</td><td headers="hd_h_niceng234er2.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>N=151</p>
|
|
<p>People with metastatic spinal cord compression.</p>
|
|
<p>Age, median, years (range): 60 (30 to 90)</p>
|
|
<p>Sex - male/female: 94/57</p>
|
|
</td><td headers="hd_h_niceng234er2.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><u>Virtual consultation</u> Virtual consultation process using telemedicine (real time sharing of patient information over internet and telephone) to facilitate the provision of multidisciplinary care between radiation oncology and spinal surgery.</td><td headers="hd_h_niceng234er2.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<u>No virtual consultation</u>
|
|
</td><td headers="hd_h_niceng234er2.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Overall survival</div></li><li class="half_rhythm"><div>Access to ser-vices
|
|
<ul class="circle"><li class="half_rhythm"><div>number of candidates for surgery missed</div></li></ul></div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_niceng234er2.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<a class="bibr" href="#niceng234er2.s1.ref4" rid="niceng234er2.s1.ref4">Guddati 2017</a>
|
|
</p>
|
|
<p>Retrospective cohort study</p>
|
|
<p>USA</p>
|
|
</td><td headers="hd_h_niceng234er2.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>N=13457</p>
|
|
<p>People with metastatic spinal cord compression.</p>
|
|
<p>Overall age not reported but number of people in age ranges given:
|
|
<ul><li class="half_rhythm"><div>18–34 N=530</div></li><li class="half_rhythm"><div>35–49 N=1962</div></li><li class="half_rhythm"><div>50–64 N=4703</div></li><li class="half_rhythm"><div>65–79 N=4789</div></li><li class="half_rhythm"><div>80 and above N=1468</div></li></ul></p>
|
|
<p>Sex - male/ female: 7895/5562</p>
|
|
</td><td headers="hd_h_niceng234er2.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<u>Early intervention</u>
|
|
</p>
|
|
<p>Intervention was classified as ‘early’ when provided within the first 48 hours and ‘late’ when provided after 48 hours of hospitalisation.</p>
|
|
</td><td headers="hd_h_niceng234er2.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<u>Late intervention</u>
|
|
</p>
|
|
<p>Intervention was classified as ‘early’ when provided within the first 48 hours and ‘late’ when provided after 48 hours of hospitalization.</p>
|
|
</td><td headers="hd_h_niceng234er2.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Overall survival
|
|
<ul class="circle"><li class="half_rhythm"><div>In-hospital mortality</div></li></ul></div></li><li class="half_rhythm"><div>Length of hospi-tal stay</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_niceng234er2.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<a class="bibr" href="#niceng234er2.s1.ref5" rid="niceng234er2.s1.ref5">Malik 2020</a>
|
|
</p>
|
|
<p>Retrospective cohort study</p>
|
|
<p>USA</p>
|
|
</td><td headers="hd_h_niceng234er2.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>N=887</p>
|
|
<p>People with spinal metastasis.</p>
|
|
<p>Overall age not reported but number of people in age ranges given:
|
|
<ul><li class="half_rhythm"><div><45 N=16</div></li><li class="half_rhythm"><div>45-64 N=204</div></li><li class="half_rhythm"><div>65-79 N=582</div></li><li class="half_rhythm"><div>≥80 N=86</div></li></ul></p>
|
|
<p>Sex - male/ female: 539/348</p>
|
|
</td><td headers="hd_h_niceng234er2.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<u>Orthopaedic surgeon</u>
|
|
</p>
|
|
<p>Surgical intervention for spinal metastasis (laminectomy, osteotomy/ corpectomy and/ or fusion) performed by an orthopaedic surgeon.</p>
|
|
</td><td headers="hd_h_niceng234er2.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<u>Neurosurgeon</u>
|
|
</p>
|
|
<p>Surgical intervention for spinal metastasis (laminectomy, osteotomy/ corpectomy and/ or fusion) performed by a neurosurgeon.</p>
|
|
</td><td headers="hd_h_niceng234er2.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Overall survival
|
|
<ul class="circle"><li class="half_rhythm"><div>90-day mortality</div></li></ul></div></li><li class="half_rhythm"><div>Emergency de-partment visits</div></li><li class="half_rhythm"><div>90-day read-missions</div></li></ul></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">AIS: American Spinal Injury Association Impairment Scale; mg: milligram; MRI: Magnetic Resonance Imaging.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng234er2tab3"><div id="niceng234er2.tab3" class="table"><h3><span class="label">Table 3</span><span class="title">Economic evidence profile of an economic evaluation of the addition of radiotherapy for people undergoing surgery for metastatic spinal cord compression</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK595815/table/niceng234er2.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng234er2.tab3_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng234er2.tab3_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng234er2.tab3_1_1_1_1" style="text-align:left;vertical-align:bottom;">Study</th><th id="hd_h_niceng234er2.tab3_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng234er2.tab3_1_1_1_2" style="text-align:left;vertical-align:bottom;">Limitations</th><th id="hd_h_niceng234er2.tab3_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng234er2.tab3_1_1_1_3" style="text-align:left;vertical-align:bottom;">Applicability</th><th id="hd_h_niceng234er2.tab3_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng234er2.tab3_1_1_1_4" style="text-align:left;vertical-align:bottom;">Other comments</th><th id="hd_h_niceng234er2.tab3_1_1_1_5" colspan="3" rowspan="1" style="text-align:center;vertical-align:bottom;">Incremental</th><th id="hd_h_niceng234er2.tab3_1_1_1_6" rowspan="2" colspan="1" headers="hd_h_niceng234er2.tab3_1_1_1_6" style="text-align:left;vertical-align:bottom;">Uncertainty</th></tr><tr><th headers="hd_h_niceng234er2.tab3_1_1_1_5" id="hd_h_niceng234er2.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Costs</th><th headers="hd_h_niceng234er2.tab3_1_1_1_5" id="hd_h_niceng234er2.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Effect</th><th headers="hd_h_niceng234er2.tab3_1_1_1_5" id="hd_h_niceng234er2.tab3_1_1_2_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cost effectivenss</th></tr></thead><tbody><tr><td headers="hd_h_niceng234er2.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>NICE 2023</p>
|
|
<p>Upskilling of team members to undertake the MSCC coordinator role to enable them to make initial clinical decisions</p>
|
|
</td><td headers="hd_h_niceng234er2.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Potentially serious limitations<sup>1</sup></td><td headers="hd_h_niceng234er2.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Directly applicable<sup>2</sup></td><td headers="hd_h_niceng234er2.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Subgrouped by deprivation quintile in secondary analysis</td><td headers="hd_h_niceng234er2.tab3_1_1_1_5 hd_h_niceng234er2.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">−£132</td><td headers="hd_h_niceng234er2.tab3_1_1_1_5 hd_h_niceng234er2.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.0470 QALYs</td><td headers="hd_h_niceng234er2.tab3_1_1_1_5 hd_h_niceng234er2.tab3_1_1_2_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Upskilling team members dominant<sup>3</sup></td><td headers="hd_h_niceng234er2.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conclusions robust to probabilistic sensitivity analysis</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="niceng234er2.tab3_1"><p class="no_margin">Weaknesses in controlling for all confounders in underlying outcome evidence</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng234er2.tab3_2"><p class="no_margin">UK NHS perspective with QALYs valued using EQ-5D utility values</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng234er2.tab3_3"><p class="no_margin">Upskilling of team members to undertake the MSCC coordinator role to enable them to make initial clinical deci-sions was both cost saving and health improving</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng234er2appjtab24"><div id="niceng234er2.appj.tab24" class="table"><h3><span class="label">Table 24</span><span class="title">Excluded studies and reasons for their exclusion</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK595815/table/niceng234er2.appj.tab24/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng234er2.appj.tab24_lrgtbl__"><table><thead><tr><th id="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reason for exclusion</th></tr></thead><tbody><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Neurosurgical National Audit Programme (NNAP)
|
|
<a href="https://www.nnap.org.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.nnap.org.uk/</a>.
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Publication type – does not match protocol - conference abstract</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Ashcroft, J., Duran, I., Hoefeler, H.
|
|
et al. (2018) Healthcare resource utilisation associated with skeletal-related events in European patients with multiple myeloma: Results from a prospective, multinational, observational study. European Journal of Haematology
|
|
100(5): 479–487 [<a href="https://pubmed.ncbi.nlm.nih.gov/29444353" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29444353</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Barzilai, Ori, Boriani, Stefano, Fisher, Charles G
|
|
et al. (2019) Essential Concepts for the Management of Metastatic Spine Disease: What the Surgeon Should Know and Practice. Global spine journal
|
|
9(1suppl): 98s–107s [<a href="/pmc/articles/PMC6512191/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6512191</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/31157152" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31157152</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Beiser, Erez, Soyfer, Viacheslav, Novikov, Ilyia
|
|
et al. (2019) A critical assessment of the quality of radiation therapy in Israel: time to initiation of treatment of spinal cord compression as an index of efficiency. Journal of neuro-oncology
|
|
143(2): 329–335 [<a href="https://pubmed.ncbi.nlm.nih.gov/31054096" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31054096</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Bollen, Laurens, Dijkstra, Sander P D, Bartels, Ronald H M A
|
|
et al. (2018) Clinical management of spinal metastases-The Dutch national guideline. European journal of cancer (Oxford, England : 1990)
|
|
104: 81–90 [<a href="https://pubmed.ncbi.nlm.nih.gov/30336360" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30336360</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Brooks, F M, Ghatahora, Ameet, Brooks, M C
|
|
et al. (2014) Management of metastatic spinal cord compression: awareness of NICE guidance. European journal of orthopaedic surgery & traumatology: orthopedie traumatologie
|
|
24suppl1: 255–9 [<a href="https://pubmed.ncbi.nlm.nih.gov/24806394" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24806394</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Charlton, P., Sabbagh, A., Shakir, R.
|
|
et al. (2018) Implementation of the Oxford Acute Referral System (OARS) an Electronic System to Document and Manage the Acute Referral of Patients with Metastatic Spinal Cord Compression (MSCC). Clinical Oncology
|
|
30: 12–s13
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Chen, Albert C; Bonnen, Mark D; Mok, Henry (2017) Onsite versus offsite radiation treatment of malignant spinal cord compression: lessons from a safety net health system. The British journal of radiology
|
|
90(1072): 20160922 [<a href="/pmc/articles/PMC5605080/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5605080</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28181815" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28181815</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Choy, W.J.; Phan, K.; Mobbs, R.J. (2019) Editorial on the integrated multidisciplinary algorithm for the management of spinal metastases. Translational Cancer Research
|
|
8(supplement2): 152–s155 [<a href="/pmc/articles/PMC8798189/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8798189</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/35117088" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 35117088</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Curtin, Mark, Piggott, Robert P, Murphy, Evelyn P
|
|
et al. (2017) Spinal Metastatic Disease: A Review of the Role of the Multidisciplinary Team. Orthopaedic surgery
|
|
9(2): 145–151 [<a href="/pmc/articles/PMC6584164/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6584164</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28544780" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28544780</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Dasenbrock, Hormuzdiyar H, Clarke, Michelle J, Thompson, Richard E
|
|
et al. (2012) The impact of July hospital admission on outcome after surgery for spinal metastases at academic medical centers in the United States, 2005 to 2008. Cancer
|
|
118(5): 1429–38 [<a href="https://pubmed.ncbi.nlm.nih.gov/22009508" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22009508</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Dasenbrock, Hormuzdiyar H, Pradilla, Gustavo, Witham, Timothy F
|
|
et al. (2012) The impact of weekend hospital admission on the timing of intervention and outcomes after surgery for spinal metastases. Neurosurgery
|
|
70(3): 586–93 [<a href="https://pubmed.ncbi.nlm.nih.gov/21869727" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21869727</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Debono, Bertrand, Braticevic, Cecile, Sabatier, Pascal
|
|
et al. (2019) The “Friday peak” in surgical referrals for spinal metastases: lessons not learned. A retrospective analysis of 201 consecutive cases at a tertiary center. Acta neurochirurgica
|
|
161(6): 1069–1076 [<a href="https://pubmed.ncbi.nlm.nih.gov/31037499" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31037499</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Dhamija, B.; Batheja, D.; Balain, B. S. (2021) A systematic review of MIS and open decompression surgery for spinal metastases in the last two decades. Journal of clinical orthopaedics and trauma
|
|
22: 101596 [<a href="/pmc/articles/PMC8488238/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8488238</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/34631409" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34631409</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Dunbar, E.M. (2020) Multidisciplinary spine oncology care across the disease continuum. Neuro-Oncology Practice
|
|
7: i1–i4 [<a href="/pmc/articles/PMC7705532/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7705532</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/33299567" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33299567</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Eleraky, Mohammed; Papanastassiou, Ioannis; Vrionis, Frank D (2010) Management of metastatic spine disease. Current opinion in supportive and palliative care
|
|
4(3): 182–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/20671554" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20671554</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Fenton, M.
|
|
et al. An electronic proforma to improve documentation for cases of metastatic spinal cord compression: A quality-improvement project. Clinical Oncology, Volume 31, e6
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Publication type - does not match protocol - conference abstract</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Gao, Z. Y., Zhang, T., Zhang, H.
|
|
et al. (2021) Effectiveness of preoperative embolization in patients with spinal metastases: a systematic review and meta-analysis. World neurosurgery [<a href="https://pubmed.ncbi.nlm.nih.gov/34153484" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34153484</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Gasbarrini, Alessandro, Li, Haomiao, Cappuccio, Michele
|
|
et al. (2010) Efficacy evaluation of a new treatment algorithm for spinal metastases. Spine
|
|
35(15): 1466–70 [<a href="https://pubmed.ncbi.nlm.nih.gov/20195197" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20195197</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Gebhardt, B.J., Rajagopalan, M.S., Gill, B.S.
|
|
et al. (2015) Impact of dynamic changes to a bone metastases pathway in a large, integrated, National Cancer Institute-designated comprehensive cancer center network. Practical Radiation Oncology
|
|
5(6): 398–405 [<a href="https://pubmed.ncbi.nlm.nih.gov/26432676" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26432676</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Publication type – does not match protocol - conference abstract</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Greif, Dylan N, Ghasem, Alexander, Butler, Alexander
|
|
et al. (2019) Multidisciplinary Management of Spinal Metastasis and Vertebral Instability: A Systematic Review. World neurosurgery
|
|
128: e944–e955 [<a href="https://pubmed.ncbi.nlm.nih.gov/31100530" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31100530</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Groenen, Karlijn H J, van der Linden, Yvette M, Brouwer, Thea
|
|
et al. (2018) The Dutch national guideline on metastases and hematological malignancies localized within the spine; a multidisciplinary collaboration towards timely and proactive management. Cancer treatment reviews
|
|
69: 29–38 [<a href="https://pubmed.ncbi.nlm.nih.gov/29870874" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29870874</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Gutt, R., Malhotra, S., Hagan, M.P.
|
|
et al. (2021) Palliative Radiotherapy within the Veterans Health Administration: Barriers to Referral and Timeliness of Treatment. JCO Oncology Practice
|
|
17(12): e1913–e1922 [<a href="https://pubmed.ncbi.nlm.nih.gov/33734865" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33734865</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Guzik, Grzegorz (2018) Analysis of factors delaying the surgical treatment of patients with neurological deficits in the course of spinal metastatic disease. BMC palliative care
|
|
17(1): 44 [<a href="/pmc/articles/PMC5842651/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5842651</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/29514666" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29514666</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Hanchanale
|
|
S, Neoh
|
|
K, Waldock
|
|
J, et al
|
|
MANAGEMENT OF METASTATIC SPINAL CORD COMPRESSION: AUDIT. BMJ Supportive & Palliative Care
|
|
2014;4:A54.
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Publication type - does not match protocol - conference abstract</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Hinojosa-Gonzalez, D. E., Roblesgil-Medrano, A., Villarreal-Espinosa, J. B.
|
|
et al. (2021) Minimally Invasive versus Open Surgery for Spinal Metastasis: A Systematic Review and Meta-Analysis. Asian spine journal [<a href="/pmc/articles/PMC9441425/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC9441425</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/34465015" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34465015</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Hsiue, Peter P, Kelley, Benjamin V, Chen, Clark J
|
|
et al. (2020) Surgical treatment of metastatic spine disease: an update on national trends and clinical outcomes from 2010 to 2014. The spine journal : official journal of the North American Spine Society
|
|
20(6): 915–924 [<a href="https://pubmed.ncbi.nlm.nih.gov/32087389" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32087389</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Huang, C.W.C., Ali, A., Chang, Y.-M.
|
|
et al. (2019) Performance of oncall radiology residents in interpreting total spine MRI studies for the detection of spinal cord compression or cauda equina compression. American Journal of Roentgenology
|
|
213(6): 1341–1347 [<a href="https://pubmed.ncbi.nlm.nih.gov/31553657" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31553657</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Khan, H.A., Rabah, N.M., Chakravarthy, V.
|
|
et al. (2021) Predictors of nonelective surgery for spinal metastases: Insights from a national database. Spine
|
|
46(24): e1334–e1342 [<a href="https://pubmed.ncbi.nlm.nih.gov/34474446" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34474446</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Kim, Ellen, McClelland, Shearwood
|
|
3rd, Jaboin, Jerry J
|
|
et al. (2021) Disparities in Patterns of Conventional Versus Stereotactic Body Radiotherapy in the Treatment of Spine Metastasis in the United States. Journal of palliative care
|
|
36(2): 130–134 [<a href="https://pubmed.ncbi.nlm.nih.gov/33356987" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33356987</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes – do not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Kumar, Naresh, Thomas, Andrew
|
|
Cherian, Ramos, Miguel Rafael
|
|
David
|
|
et al. (2021) Readmission-Free Survival Analysis in Metastatic Spine Tumour Surgical Patients: A Novel Concept. Annals of surgical oncology
|
|
28(5): 2474–2482 [<a href="https://pubmed.ncbi.nlm.nih.gov/33393052" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33393052</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Kurisunkal, Vineet; Gulia, Ashish; Gupta, Srinath (2020) Principles of Management of Spine Metastasis. Indian journal of orthopaedics
|
|
54(2): 181–193 [<a href="/pmc/articles/PMC7096601/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7096601</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32257036" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32257036</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Lacey, Craig, Ockwell, Clare, Locke, Imogen
|
|
et al. (2015) A prospective study comparing radiographer- and clinician-based localization for patients with metastatic spinal cord compression (MSCC) to assess the feasibility of a radiographer-led service. The British journal of radiology
|
|
88(1055): 20150586 [<a href="/pmc/articles/PMC4743470/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4743470</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26283103" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26283103</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Lawton, Andrew J, Lee, Kathleen A, Cheville, Andrea L
|
|
et al. (2019) Assessment and Management of Patients With Metastatic Spinal Cord Compression: A Multidisciplinary Review. Journal of clinical oncology : official journal of the American Society of Clinical Oncology
|
|
37(1): 61–71 [<a href="https://pubmed.ncbi.nlm.nih.gov/30395488" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30395488</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Levack, P., Graham, J., Collie, D.
|
|
et al. (2002) Don’t wait for a sensory level - Listen to the symptoms: A prospective audit of the delays in diagnosis of malignant cord compression. Clinical Oncology
|
|
14(6): 472–480 [<a href="https://pubmed.ncbi.nlm.nih.gov/12512970" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12512970</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparator – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Lo, S.S.-M., Ryu, S., Chang, E.L.
|
|
et al. (2015) ACR Appropriateness Criteria Metastatic Epidural Spinal Cord Compression and Recurrent Spinal Metastasis. Journal of Palliative Medicine
|
|
18(7): 573–584 [<a href="https://pubmed.ncbi.nlm.nih.gov/25974663" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25974663</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Lo, Wan-Yu and Yang, Shu-Hua (2017) Metastatic spinal cord compression (MSCC) treated with palliative decompression: Surgical timing and survival rate. PloS one
|
|
12(12): e0190342 [<a href="/pmc/articles/PMC5747484/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5747484</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/29287117" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29287117</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparator – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Macdonald, A Graham, Lynch, Daniel, Garbett, Ian
|
|
et al. (2019) Malignant spinal cord compression. The journal of the Royal College of Physicians of Edinburgh
|
|
49(2): 151–156 [<a href="https://pubmed.ncbi.nlm.nih.gov/31188350" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31188350</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparator – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
McLinton
|
|
A, Hutchison
|
|
C. Malignant spinal cord compression: a retrospective audit of clinical practice at a UK regional cancer centre. Br J Cancer. 2006
|
|
Feb
|
|
27;94(4):486–91 [<a href="/pmc/articles/PMC2361169/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2361169</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/16434993" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16434993</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparator – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Newman, William Christopher, Patel, Ankur, Goldberg, Jacob L
|
|
et al. (2020) The importance of multidisciplinary care for spine metastases: initial tumor management. Neuro-oncology practice
|
|
7(suppl1): i25–i32 [<a href="/pmc/articles/PMC7705527/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7705527</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/33299571" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33299571</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Paulino Pereira, N. R., Groot, O. Q., Verlaan, J. J.
|
|
et al. (2021) Quality of Life Changes After Surgery for Metastatic Spinal Disease: A Systematic Review and Meta-analysis. Clinical spine surgery [<a href="https://pubmed.ncbi.nlm.nih.gov/34108371" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34108371</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Pease, N.J
|
|
et al. Development and audit of a care pathway for the management of patients with suspected malignant spinal cord compression. Physiotherapy, Volume 90, Issue 1, 27–34
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Other protocol criteria - duplicate publication.</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Pease, N.J.; Harris, R.J.; Finlay, I.G. (2004) Development and audit of a care pathway for the management of patients with suspected malignant spinal cord compression. Physiotherapy
|
|
90(1): 27–34
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Other protocol criteria - duplicate publication.</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Pennington, Zach, Porras, Jose L, Larry Lo, Sheng-Fu
|
|
et al. (2021) International Variability in Spinal Metastasis Treatment: A Survey of the AO Spine Community. Global spine journal: 21925682211046904 [<a href="/pmc/articles/PMC10448098/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC10448098</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/34565202" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34565202</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Philipps, L.
|
|
et al. An Audit of Metastatic Cord Compression Pathways. Clinical Oncology, Volume 30, S4
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Publication type – does not match protocol - conference abstract</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Pipola, Valerio, Terzi, Silvia, Tedesco, Giuseppe
|
|
et al. (2018) Metastatic epidural spinal cord compression: does timing of surgery influence the chance of neurological recovery? An observational casecontrol study. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
|
|
26(9): 3181–3186 [<a href="https://pubmed.ncbi.nlm.nih.gov/29600414" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29600414</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Rades, Dirk, Janssen, Stefan, Conde-Moreno, Antonio Jose
|
|
et al. (2017) Role of the overall treatment time of radiotherapy with 10 × 3 Gy for outcomes in patients with metastatic spinal cord compression. Journal of medical imaging and radiation oncology
|
|
61(3): 388–393 [<a href="https://pubmed.ncbi.nlm.nih.gov/27804231" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27804231</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Ratanatharathorn, V. and Powers, W.E. (1991) Epidural spinal cord compression from metastatic tumor: Diagnosis and guidelines for management. Cancer Treatment Reviews
|
|
18(1): 55–71 [<a href="https://pubmed.ncbi.nlm.nih.gov/1933911" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1933911</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Richards, Lena, Misra, Vivek, Verma, Rajat
|
|
et al. (2017) 86 - Metastatic Spinal Cord Compression (MSCC) – Collaborative Work between the Tertiary Cancer Centre and the Specialist Spinal Centre Since the Introduction of the MSCC Coordinator Service Has Seen a Marked Increase in Surgical Rates, with 20% of Patients Who Presented with MSCC in the First 24 Months Having Spinal Surgery. This Has Resulted in Improved Survival Rates for MSCC Patients in Greater Manchester and Cheshire. Spine Journal
|
|
17: 30–s31
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Publication type – does not match protocol - conference abstract</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Rudra, Soumon, Lauman, Mary K, Stowe, Hayley
|
|
et al. (2020) Evaluation of the Metastatic Spine Disease Multidisciplinary Working Group Algorithms as Part of a Multidisciplinary Spine Tumor Conference. Global spine journal
|
|
10(7): 888–895 [<a href="/pmc/articles/PMC7485068/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7485068</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32905719" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32905719</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparator – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Schilling, Andrew, Pennington, Zach, Ehresman, Jeff
|
|
et al. (2021) Impact of Multidisciplinary Intraoperative Teams on Thirty-Day Complications After Sacral Tumor Resection. World neurosurgery
|
|
152: e558–e566 [<a href="https://pubmed.ncbi.nlm.nih.gov/34144170" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34144170</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Services, NHS and Mike Hutton GIRFTClinical Lead for, Spinal (2019) Spinal Services GIRFT Programme National Specialty Report.
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Shah, S.
|
|
et al. (2021) Management of Metastatic Spinal Cord Compression in Secondary Care: A Practice Reflection from Medway Maritime Hospital, Kent, UK. J. Pers. Med. [<a href="/pmc/articles/PMC7914482/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7914482</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/33572084" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33572084</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Other protocol criteria - duplicate publication.</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Shah, Sidrah, Kutka, Mikolaj, Lees, Kathryn
|
|
et al. (2021) Management of Metastatic Spinal Cord Compression in Secondary Care: A Practice Reflection from Medway Maritime Hospital, Kent, UK. Journal of personalized medicine
|
|
11(2) [<a href="/pmc/articles/PMC7914482/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7914482</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/33572084" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33572084</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparator – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Souchon, R., Wenz, F., Sedlmayer, F.
|
|
et al. (2009) DEGRO practice guidelines for palliative radiotherapy of metastatic breast cancer: BBBone metastases and metastatic spinal cord compression (MSCC). Strahlentherapie und Onkologie
|
|
185(7): 417–424 [<a href="https://pubmed.ncbi.nlm.nih.gov/19714302" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19714302</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Spratt, Daniel E, Beeler, Whitney H, de Moraes, Fabio Y
|
|
et al. (2017) An integrated multidisciplinary algorithm for the management of spinal metastases: an International Spine Oncology Consortium report. The Lancet. Oncology
|
|
18(12): e720–e730 [<a href="https://pubmed.ncbi.nlm.nih.gov/29208438" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29208438</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Steinberger, Jeremy M, Yuk, Frank, Doshi, Amish H
|
|
et al. (2020) Multidisciplinary management of metastatic spine disease: initial symptom-directed management. Neuro-oncology practice
|
|
7(suppl1): i33–i44 [<a href="/pmc/articles/PMC7705525/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7705525</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/33299572" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33299572</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Tabacof, L., Delgado, A., Dewil, S.
|
|
et al. (2021) Safety and Feasibility of Outpatient Rehabilitation in Patients with Secondary Bone Cancer: A Preliminary Study. Rehabilitation Oncology
|
|
39(3): e42–e50
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparator – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Tarawneh, Ahmad M; Pasku, Dritan; Quraishi, Nasir A (2021) Surgical complications and re-operation rates in spinal metastases surgery: a systematic review. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
|
|
30(10): 2791–2799 [<a href="https://pubmed.ncbi.nlm.nih.gov/33184702" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33184702</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Tsukada, Y., Nakamura, N., Ohde, S.
|
|
et al. (2015) Factors that delay treatment of symptomatic metastatic extradural spinal cord compression. Journal of Palliative Medicine
|
|
18(2): 107–113 [<a href="https://pubmed.ncbi.nlm.nih.gov/25343305" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25343305</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention – does not match protocol - study shows treatment is delayed if patients present on weekend.</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
van Tol, Floris R, Choi, David, Verkooijen, Helena M
|
|
et al. (2019) Delayed presentation to a spine surgeon is the strongest predictor of poor postoperative outcome in patients surgically treated for symptomatic spinal metastases. The spine journal : official journal of the North American Spine Society
|
|
19(9): 1540–1547 [<a href="https://pubmed.ncbi.nlm.nih.gov/31005624" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31005624</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention – does not match protocol - study shows poorer outcomes for patients where treatment was delayed.</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
van Tol, Floris R, Massier, Julie R A, Frederix, Geert W J
|
|
et al. (2021) Costs Associated With Timely and Delayed Surgical Treatment of Spinal Metastases. Global spine journal: 2192568220984789 [<a href="/pmc/articles/PMC9609516/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC9609516</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/33511876" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33511876</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Vellayappan, B.A., Kumar, N., Chang, E.L.
|
|
et al. (2018) Novel multidisciplinary approaches in the management of metastatic epidural spinal cord compression. Future Oncology
|
|
14(17): 1665–1668 [<a href="https://pubmed.ncbi.nlm.nih.gov/29939082" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29939082</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Wallace, Adam N, Robinson, Clifford G, Meyer, Jeffrey
|
|
et al. (2019) The Metastatic Spine Disease Multidisciplinary Working Group Algorithms. The oncologist
|
|
24(3): 424 [<a href="/pmc/articles/PMC6519761/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6519761</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30867318" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30867318</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
White, B D, Stirling, A J, Paterson, E
|
|
et al. (2008) Diagnosis and management of patients at risk of or with metastatic spinal cord compression: summary of NICE guidance. BMJ (Clinical research ed.)
|
|
337: a2538 [<a href="https://pubmed.ncbi.nlm.nih.gov/19039017" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19039017</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Zaveri, Gautam R, Jain, Reetu, Mehta, Nishank
|
|
et al. (2021) An Overview of Decision Making in the Management of Metastatic Spinal Tumors. Indian journal of orthopaedics
|
|
55(4): 799–814 [<a href="/pmc/articles/PMC8192670/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8192670</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/34194637" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34194637</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design – does not match protocol</td></tr><tr><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Zehri, Aqib H, Peterson, Keyan A, Lee, Katriel E
|
|
et al. (2022) National trends in the surgical management of metastatic lung cancer to the spine using the national inpatient sample database from 2005 to 2014. Journal of clinical neuroscience: official journal of the Neurosurgical Society of Australasia
|
|
95: 88–93 [<a href="https://pubmed.ncbi.nlm.nih.gov/34929657" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34929657</span></a>]
|
|
</td><td headers="hd_h_niceng234er2.appj.tab24_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention – does not match protocol</td></tr></tbody></table></div></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
|
|
|
|
|
|
|
|
|
|
<!-- Book content -->
|
|
|
|
<script type="text/javascript" src="/portal/portal3rc.fcgi/rlib/js/InstrumentNCBIBaseJS/InstrumentPageStarterJS.js"> </script>
|
|
|
|
|
|
<!-- CE8B5AF87C7FFCB1_0191SID /projects/books/PBooks@9.11 portal107 v4.1.r689238 Tue, Oct 22 2024 16:10:51 -->
|
|
<span id="portal-csrf-token" style="display:none" data-token="CE8B5AF87C7FFCB1_0191SID"></span>
|
|
|
|
<script type="text/javascript" src="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/js/3968615.js" snapshot="books"></script></body>
|
|
</html>
|