Diagnosis and Treatment of Vertebral Column Metastases

Abstract

The vertebral column is recognized as the most common site for bony metastases in patients with systemic malignancy. Patients with metastatic spinal tumors may present with pain, neurologic deficit, or both. Some tumors are asymptomatic and are detected during screening examinations. Treatment options include medical therapy, surgery, and radiation. However, diversity of patient condition, tumor pathology, and anatomical extent of disease complicate broad generalizations for treatment. Historically, surgery was considered the most appropriate initial therapy in patients with spinal metastasis with the goal of eradication of gross disease. However, such an aggressive approach has not been practical for many patients. Now, operative intervention is often palliative, with pain control and maintenance of function and stability the major goals. Surgery is reserved for neurologic compromise, radiation failure, spinal instability, or uncertain diagnosis. Recent literature has revealed that surgical outcomes have improved with advances in surgical technique, including refinement of anterior, lateral, posterolateral, and various approaches to the anterior spine, where most metastatic disease is located. We review these surgical approaches for which a team of surgeons often is needed, including neurosurgeons and orthopedic, general, vascular, and thoracic surgeons. Overall, a multimodality approach is useful in caring for these patients. It is important that clinicians are aware of the various therapeutic options and their indications. The optimal treatment of individual patients with spinal metastases should include consideration of their neurologic status, anatomical extent of disease, general health, age, and qualilty of life.

Estudo da aplicabilidade do escore de Tokuhashi modificado nos pacientes tratados cirurgicamente de metástases vertebrais

“…The great majority of vertebral tumor lesions consist of secondary lesions, especially in adult patients (2) . Around 50% to 70% of the patients who die because of malignant neoplasia present bone metastases in the spine (2,10) .…”

Interpretation of MR Imaging of Spinal Metastasis: Focus on the Understanding of Its Pathophysiology and the Next Step toward a Further Clinical Approach Using MRI Findings

“…These clinical representations of spinal metastasis seem to be correlated with the pathophysiology of the spinal metastasis described in the past (4). Therefore, we propose two learning objectives in our study.…”

“…Spinal metastasis can occur in three regions including the extradural, intradural extramedullary, and intramedullary regions (4). As most spinal metastases (more than 98%) occur in an extradural location, anatomical classification of the extradural location is very important (8).…”

Outcome of Palliative Single Posterior Reconstruction Surgery for Metastatic Spinal Tumor

“…Therefore, a posterior-alone procedure without any anterior augmentation, may carry the risk of worse clinical and radiological outcome through the follow-up [24]. Sundaresan et al described 101 consecutive patients suffering from cervical, thoracic, and lumbar metastasis with anterior vertebral body resection and stabilization with methyl methacrylate and Steinmann pins, and they reported that additional augmentation using posterior instrumentation was required for 10% of them [16,17].…”