Background MSCC is estimated to occur in 5–10% of cancer patients. Prompt diagnosis and treatment is essential to prevent paralysis. Failure to recognise early signs can have devastating implications, including the financial burden of care for patients who become bedbound and with earlier than expected death.

Aims(s) The service was launched in 2013 covering a population of 3.5 million. It has significantly improved the care of patients who develop this distressing condition across our region. Education is integral to the role and has raised awareness amongst patients and clinicians of the early signs.

Methods The service provides a single point of contact for all health-care sectors. It offers advice and coordinated care based on evidence-based guidelines and a robust network pathway. Patients are triaged and referred for surgery, radiotherapy, systemic treatment or best supportive care. All patients are offered rehabilitation. Data are collected prospectively for service evaluation.

Results Evaluation has demonstrated significant improvements. In the first four years, 2635 patients were referred. 96% had an MR scan within 24 hours, out of these, 1133 had confirmed MSCC and 345 had impending cord compression. 16% of patients were treated with surgery (this is a three-fold increase since before the service) and 64% with radiotherapy, also within 24 hours.

Conclusion Awareness amongst patients and clinicians has significantly increased resulting in timely diagnosis, treatment and rehabilitation. Earlier diagnosis also has the potential to prevent MSCC in the future. Back pain is managed earlier and patients remain ambulant with improved survival, reducing hospital admissions with overall financial benefits.