Spinal metastases: secondary cancer in the spine — recognition, investigation, and management
Known history of cancer — any new or changed back pain needs same-week assessment • Constant back pain not relieved by any position, present at rest and at night • Unexplained weight loss • Rapidly worsening leg weakness, bladder or bowel changes — go to A&E now • Age over 50 with new back pain and no clear mechanical cause.
What are spinal metastases?
Spinal metastases are deposits of cancer cells that have spread from a primary tumour elsewhere in the body to the bones of the spine. The spine is the most common site of bone metastases overall. They can cause pain, structural instability, and — if they compress the spinal cord or nerve roots — serious neurological compromise.
Most common primary cancers that spread to the spine
How to recognise it — key features
- Constant back pain — present at rest, at night, and not relieved by any position
- Night pain that wakes you from sleep — a highly specific red flag
- Unexplained weight loss alongside back pain
- History of cancer — any previous cancer diagnosis makes spinal metastases a primary consideration
- Age over 50 with new back pain and no clear mechanical cause
- Pain that does not follow a mechanical pattern — not better with rest, not worse with specific movements
If you have ever been diagnosed with cancer and develop new or changed back pain, contact your oncology team or GP immediately. Do not assume it is a coincidence or a muscle strain. New back pain in someone with a cancer history requires imaging until metastatic disease has been excluded.
Management
Management of spinal metastases is directed by a multidisciplinary team including oncology, spinal surgery, and palliative care. Treatments include systemic therapy (chemotherapy, targeted therapy, hormone therapy), radiotherapy to the affected spinal levels, bisphosphonates or denosumab for bone protection, surgical stabilisation where instability or cord compression is present, and pain management.