Risk Factors and Probability of Vertebral Body Collapse in Metastases of the Thoracic and Lumbar Spine

Taneichi, Hiroshi; Kaneda, Kiyoshi; Takeda, Naokazu; Abumi, Kuniyoshi; Satoh, Shun

doi:10.1097/00007632-199702010-00002

Cited by 222 publications

(160 citation statements)

References 20 publications

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“…In cases of primary thyroid tumour, surgery is always indicated for maximal removal of bone lesions, and to allow iodotherapy to be effective [15]. According to Taneichi et al [17], surgery should also be considered when the risk of impending collapse is considerable: more than 50-60% involvement of the vertebral body with no destruction of adjacent structures, or 25-30% involvement with costo-vertebral joint destruction in the thoracic spine; and 35-40% involvement of vertebral body or 20-25% involvement with posterior elements destruction in the thoracolumbar and lumbar spine. Some patients presenting with class 2 according to the Harrington classification should therefore be considered for surgery according to Taneichi and colleagues.…”

Section: Discussionmentioning

confidence: 99%

Surgery in spinal metastasis without spinal cord compression: indications and strategy related to the risk of recurrence

Chataigner

Onimus

2000

European Spine Journal

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IntroductionPain is the most common symptom in patients presenting with spinal metastasis without neural compromise. Surgery, radiotherapy and vertebroplasty are all effective treatments alone or in combination. According to Boland et al. [1], early aggressive treatment may be considered to avoid cord compression. The aim of this study is to determine indications and strategy of surgical treatment related to the length of survival and to the risk of recurrence. Materials and methodsOne hundred and seven patients were operated on for spinal metastasis without spinal cord compression. There were 54 women and 53 men, with a mean age of 58 (range 29-87). Neoplasm was revealed by spinal metastasis in seven cases. In the other cases, neoplasm had been known about for a mean period of 30 months (range 0-288 months). The primary tumour was predominantly lung neoplasm (37 cases), followed by breast neoplasm (30 cases), unknown (9 cases), kidney (8 cases), digestive tract (6 cases), others (17 cases). There were only two cases of primary prostate neoplasm. Back pain was the main symptom in all cases, with radiculopathy in 43 cases. Pyramidal irritation (Babinski sign, hyper-reAbstract Surgery in patients presenting with vertebral metastasis without neural deficit is controversial. A series of 107 patients (54 female, 53 male) were operated on at a mean age of 58. The metastasis was the first manifestation of the cancer in seven cases. In 100 patients, the cancer had been diagnosed 30 months earlier (average). Vertebral pain was present in all cases, with associated radicular pain in 43 cases. Pyramidal irritation without neural deficit was present in seven cases. The mean preoperative Karnofsky index was 64.7%. The mean preoperative Tokuhashi score was 8.6. The surgical approach depended on the topography of the metastasis. Ninety-three patients were dead at review, with a mean survival of 8 months. Seventeen patients underwent further spinal surgery, for local recurrence in nine cases, and for another spinal localization in eight cases, after a mean interval of 8 months. Recurrence occurred at the same level in all seven patients presenting with neural deficit at recurrence. Among ten recurrences without neural deficit, two were observed at the same level and eight were observed on another level. Surgery in vertebral metastasis without neural deficit results in substantial functional improvement, but does not increase the duration of life. For kidney metastasis, total vertebrectomy must be performed because of the risk of recurrence. For thyroid metastasis, total vertebrectomy is a good alternative to increase the efficacy of iodotherapy. In other cases, for patients with good general status, surgery must be adapted to the location of the involvement.

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Section: Discussionmentioning

confidence: 99%

Surgery in spinal metastasis without spinal cord compression: indications and strategy related to the risk of recurrence

Chataigner

Onimus

2000

European Spine Journal

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“…Furthermore, radical surgery with a curative intent seems to be not indicated based on the high radiosensitivity of the tumours with a local control rate reported to range within 80-100 % [4]. Surgery is recommended in cases of instability or neurologic impairment [5,6]. In contrast, progression into multiple myeloma has been reported to occur in 50-60 % of patients with SP, after initial radiation therapy [7][8][9].…”

Section: Review Of the Condition And Evidence-based Literaturementioning

confidence: 99%

“…In addition, the median time to progression was demonstrated to range between 2 and 4 years, particularly in the spine [7][8][9]. The median overall survival time varied from 7.5 to 12 years after radiation therapy alone [5,10]. The overall survival in solitary plasmacytoma of the bone is significantly lower compared to the extramedullary type.…”

Section: Review Of the Condition And Evidence-based Literaturementioning

confidence: 99%

“…Yet, randomized studies confirming its superiority over surgery alone or in combination do not exist. Moreover, surgical interventions prove to be supportive in SP mostly in cases involving neurologic impairment or spinal instability [5]. Huang et al [20] recommend surgery (piecemeal manner) with adjuvant radiotherapy for solitary plasmacytoma of the cervical spine in patients with neurological lesions and spinal instability.…”

Section: Review Of the Condition And Evidence-based Literaturementioning

confidence: 99%

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Total spondylectomy for solitary bone plasmacytoma of the lumbar spine in a young woman: a case report and review of literature

et al. 2013

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Introduction Solitary bone plasmacytoma (SP) is a rare diagnosis for which the primary treatment is local radiotherapy. There is no established consensus suggesting a total spondylectomy in spinal SP. Materials and Methods We report the case of a 43-yearold woman with solitary plasmacytoma of the lumbar spine treated with complete vertebral resection. Radiographs, CT scan and MRI showed a single osteolytic lesion of the third lumbar vertebra. Further diagnostics following recommended algorithm for tumour screening were negative.

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“…A study by Taneichi et al (24), determined the risk factors for vertebral body collapse caused by metastases, estimated the probability of collapse under various states of metastatic involvement, and established the criteria for impending vertebral body collapse. The risk factors for vertebral body collapse in the thoracic region (T1-T10) were tumor size and costovertebral joint destruction, whereas in the thoracolumbar and lumbar spine (T10-L5), tumor size and pedicle destruction were the main factors.…”

Section: ------------------------------------------------------------mentioning

confidence: 99%

Instability and impending instability of the thoracolumbar spine in patients with spinal metastases: a systematic review

Weber

Burch²,

Buckley³

et al. 2010

Int J Oncol

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Abstract. Metastatic disease commonly occurs in the spine and incidence is likely to increase secondary to improved survival rates in many cancer patients. Despite published research on instability in patients with metastatic disease of the thoracolumbar spine, controversy exists regarding risk factors for instability and indications for surgical stabilization. The objective of this systematic review was to determine what defines instability and impending instability in patients with metastatic disease of the thoracic and lumbar spine. We systematically reviewed the medical literature in order to identify all the relevant studies concerning patients with metastatic involvement of T1-L5, in the domains of biomechanics, epidemiology, clinical issues, and radiographic parameters. Two independent observers performed study selection, methodological quality assessment, and data extraction in a blinded and objective manner for all the identified studies. We were then able to define the criteria to identify instability of the spine with metastases. A literature search and review identified 14 relevant, good quality studies for inclusion. The predictors of instability included increased tumor size, a larger cross-sectional area of bone defect, increased force of spinal loading, decreased bone density, posterior location of the tumor within the vertebrae, destruction of the costovertebral joint, pedicle destruction in the thoracolumbar spine, increased axial rigidity, and sagittal spinal deformity. Definitive conclusions cannot be reached due to lack of evidence. However, variables such as tumor size, magnitude of spinal loading, bone density, tumor location within the vertebrae and spine, and tumor type are risk factors for instability in spinal metastases. Improved clinical research methodology for this patient population is required.

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Risk Factors and Probability of Vertebral Body Collapse in Metastases of the Thoracic and Lumbar Spine

Cited by 222 publications

References 20 publications

Surgery in spinal metastasis without spinal cord compression: indications and strategy related to the risk of recurrence

Surgery in spinal metastasis without spinal cord compression: indications and strategy related to the risk of recurrence

Total spondylectomy for solitary bone plasmacytoma of the lumbar spine in a young woman: a case report and review of literature

Instability and impending instability of the thoracolumbar spine in patients with spinal metastases: a systematic review

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