MOSS: A Patient-Centered Approach

  • Rex A. W. Marco
  • Joseph Brindise
  • David Dong


The treatment of metastatic spinal cord compression (MSCC) is complex and varies from patient to patient. There are numerous treatment algorithms and mnemonics designed to reduce uncertainty in treatment planning and thereby expedite treatment. There are also prospective, randomized studies that are similarly designed to simplify planning and thereby optimize treatment in these patients. We have found, however, that some of these methods of planning treatment oversimplify what is in reality a complex, ever-changing clinical scenario. These various methods also place a greater emphasis on the degree of the spinal cord compression than on more patient-centered variables. We have developed a mnemonic that we believe will expedite decision-making, and more importantly, will do so in the context of patient-specific variables. We believe that only such a patient-centered approach to treatment planning can reliably ensure an optimal outcome in the patient with MSCC. The mnemonic, MOSS, stands for medical/mental, oncologic, stenosis, and stability. This memory aid requires the practitioner to first assess the patient’s medical and mental condition, and their oncologic diagnosis, prognosis, and stage, before gauging the degree of spinal cord compression, neurologic loss, or spinal instability. Specifically, treatment in a patient in a poor mental and medical state whose cancer is very advanced should likely be different from that in the patient in a better mental and medical state whose compression may be very similar to that in the sicker patient. MOSS also requires the joint participation of the multidisciplinary team in both the assessment phase and the selection of adjuvant and up-to-date technology for treatment. The old saying that a rolling stone gathers no MOSS applies in a more modern sense to those who are willing to consider and adopt new ideas and to abandon approaches to the treatment of MSCC that emphasize surgical intervention rather than evaluation of the patient and current medical and surgical treatment options. The treatment for MSCC in its various manifestations is continuously changing, and patient-centered decision-making, such as that afforded by MOSS, will help ensure that the best of these new techniques and technology are used in those patients in the best position to benefit from them.


MOSS Patient centered Spinal cord compression Spinal metastases Decision-making Algorithm 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Rex A. W. Marco
    • 1
  • Joseph Brindise
    • 2
  • David Dong
    • 2
  1. 1.Department of Orthopaedic SurgeryHouston Methodist HospitalHoustonUSA
  2. 2.Department of Orthopedics and Sports MedicineHouston Methodist HospitalHoustonUSA

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