Multidisciplinary Approach to Spinal Metastases and Metastatic Spinal Cord Compression—A New Integrative Flowchart for Patient Management

Abstract

Metastatic spine disease (MSD) and metastatic spinal cord compression (MSCC) are major causes of permanent neurological damage and long-term disability for cancer patients. The development of MSD is pathophysiologically framed by a cooperative interaction between general mechanisms of bone growth and specific mechanisms of spinal metastases (SM) expansion. SM most commonly affects the thoracic spine, even though multiple segments may be affected concomitantly. The great majority of SM are extradural, while intradural-extramedullary and intramedullary metastases are less frequently seen. The management of patients with SM is particularly complex and challenging, with multiple factors—such as the spinal stability status, primary tumor radio and chemosensitivity, cancer biological burden, patient performance status and comorbidities, and patient’s oncological prognosis—influencing the clinical decision-making process. Different frameworks were developed in order to systematize and support this process. A multidisciplinary, personalized approach, enriched by the expertise of each involved specialty, is crucial. We reviewed the most recent evidence and proposed an updated algorithmic approach to patients with MSD according to the clinical scenario of each patient. A flowchart-based approach offers an evidence-based management of MSD, providing a valuable clinical decision tool in a context of high uncertainty and quick-acting need.

Clinical efficacy analysis of surgical treatment for spinal metastasis under the multidisciplinary team using the NOMS decision system combined with the revised Tokuhashi scoring system: a randomized controlled study

“…Through multidisciplinary evaluation considering the patient’s physical condition, organ function, examination results, and relevant scores, a standardized and personalized treatment plan was formulated using the NOMS decision system and the improved Tokuhashi scoring system. This allows for comprehensive and individualized treatment at the appropriate time, maximizing patient benefits [ 8 ]. (2) It significantly improves patients’ quality of life, reduces hospitalization time, decreases intraoperative and postoperative complications, and lowers patient mortality rates.…”

“…The Revised Tokuhashi scoring system is widely regarded as the most extensive and effective system for evaluating spinal metastases [ 7 ]. In recent years, with the rapid development of multidisciplinary teams (MDTs) in clinical settings, important achievements have been made in the treatment of spinal metastases [ 8 ]. The accuracy of the traditional modified Tokuhashi scoring system has been gradually reduced, and it fails to provide more suitable treatment plans.…”

Evaluation of Epidemiological and Pathological Features of Symptomatic Spinal Metastases in Romania—What Could We Learn from a Retrospective Study?

“…Over time, various theories have appeared regarding the mechanisms of SM. Thus, various authors assumed that they can develop either by hematogenous, venous or arterial dissemination, by direct tumor extension, by lymphatic dissemination, and by subarachnoid and leptomeningeal seeding [7,8]. Recently, a new theory has emerged, i.e., that the center of the vertebral body is the primary niche for the development of complex interactions between metastatic cancer cells and the vertebral bone environment, with subsequent posterior dissemination via pedicles [1].…”

Systematic Review and Meta-Analysis on Optimal Timing of Surgery for Acute Symptomatic Metastatic Spinal Cord Compression

“…According to our study, it is best to schedule surgery within 48 h of symptom presentation for MSCC. This is because patients can be better prepared for the operation while the neurological window for potential improvement is still open during this period [22]. This applies not only to the surgery itself but also to the need for an optimized radiological and medical preoperative workout, a multimodal pathway, and well-established communication lines between professionals, such as the emergency physician, medical oncologist, radio-oncologist, and spinal surgeon [22].…”