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PATIENT POSITIONING (MOBILIZATION) AND BRACING FOR PAIN RELIEF AND SPINAL STABILITY IN METASTATIC SPINAL CORD COMPRESSION IN ADULTS

This review should be cited as: Lee SH, Cox KM, Grant R, Kennedy C, Kilbride L. Patient positioning (mobilisation) and bracing for pain relief and spinal stability in metastatic spinal cord compression in adults. Cochrane Database of Systematic Reviews 2012, Issue 3. Art. No.: CD007609. DOI: 10.1002/14651858.CD007609.pub2. The authors state: “Many patients with metastatic spinal cord compression (MSCC) have spinal instability but are determined, by their clinician, to be unsuitable for surgical internal fixation due to their advanced disease. Mobilisation may be hazardous in the presence of spinal instability as further vertebral collapse can occur. Current guidance on positioning (or mobilisation) and spinal bracing is contradictory.” In light of these, they set out to investigate the correct positioning (or mobilization) and examine the effects of spinal bracing to relieve pain or to prevent further vertebral collapse in patients with MSCC. Despite an heroic search and screening over 1600 potentially relevant studies, no studies met the inclusion criteria. Many papers identified the importance of mobilization but no randomized controlled trials (RCTs) have been undertaken. It is time these were undertaken.