Metastatic spinal cord compression (MSCC) exists when pressure on the spinal cord or its vascular supply occurs; arising from soft tissue tumour, fracture of spinal column, or a combination of soft tissue and bony intrusion. Care of the compressed spinal cord often includes protecting spinal alignment by avoidance or restrictions on range of movement, maintenance of cord perfusion by lying supine.
There are some patients who are too unwell for any intervention and will be given supportive care only. Others, though suitable for treatment are not fit enough for surgery but may be appropriately treated with radiotherapy, and there are those who may have radio resistant tumours, and with poor prognosis too frail to justify the risk of surgery.
Mechanical pain is suggestive of spinal column instability; further damage might be provoked by inappropriate mobilisation pre/post and during treatment. CT, plain X-ray, and MRI may indicate that the spine is not at immediate risk from instability. This will allow cautious movement to proceed. Although imaging is helpful in grading effectiveness of surgical stabilisation procedures, it is difficult to assess the effect of radiotherapy and at what stage mobilisation is safe by imaging alone.
In palliative scenarios, or those clients who are unfit for surgery, who have severe mechanical pain +/- imaging evidence of spinal instability an external spinal support may be indicated alongside the client’s consent.
The MKS Lumbo Forte has been a great success for this group; tolerated exceptionally well for those with metastatic involvement at levels of L4 – L2. The Lumbo Forte has a perfect balance of comfort and support of the elastic bandage wrap intimate to torso, with a semi-rigid frame that is external for great compliance. It is conformable to any shape, offering lateral trunk and pelvic support.
Often a changing torso which is commonly seen in this group of clients with fluctuating BMI in short periods of time can require resizing/or new braces ordering, but the adjustability of the Lumbo Forte has prevented any need. Clients are very well supported by the frame, but do not feel too heavily restricted; the breathable elastic bandage has not been found to irritate skin subjected to radiotherapy.
For clients who are supine or due to medication and struggle with orthostatic hypotension when brought into an upright/ambulatory state, the compressive nature of the high abdomen section which is mildly reinforced has been helpful in raising blood pressure satisfactorily.
Handily the abdominal front has two independent lay over sections so fit can be tailored to fit the most challenging torsos top and bottom. It has to date accommodated pendulous abdomens, sensitive ribs, and those with a decreased lung capacity competently due to the ability to have independent tensions top and bottom, and this is true of the rigid support whose fulcrums straps have individual straps courses with control of tension and position.
A custom comfortable fit from an off the shelf brace.