Spinale Mammakarzinommetastasen aus Sicht der Wirbelsäulenchirurgie

Abstract

Breast cancer is the most common malignancy affecting women and the spinal column is most likely affected by metastases. Modern oncologic treatment options have significantly prolonged survival times in the last decade. Therefore, treatment of vertebral metastases has been of special interest in spine surgery. Different scores are described to evaluate prognosis and to choose correct treatment strategies, which however only differentiate tumor entities and not specific tumor phenotypes. Breast cancer has been classified into five intrinsic subtypes with different survival rates since the turn of the millennium. The aim of this review was to describe molecular predictors of breast cancer malignancy and to better estimate expected survival times and invasiveness of therapies with regard to spinal metastases.

Surgical Efficacy and Prognosis of 54 Cases of Spinal Metastases from Breast Cancer

“…And it is one of the malignant tumors most prone to bone metastasis, which is reported to occur in 65%-75% of patients with advanced breast cancer (2). Due to the multi-segments, rich and slow blood ow, spine is a common site for bone metastasis (3). Bone metastasis can lead to skeletal-related events (SREs), including hyper calcemia, pathological fracture, spinal cord compression and pain (4).…”

Biomechanical Study of a Novel, Expandable, Non-Metallic and Radiolucent CF/PEEK Vertebral Body Replacement (VBR)

“…Most spinal metastases are located anteriorly in the vertebral body and in the peridural space, while a dorsal location is rare [4,6,10,11,12,14]. The incidence of clinically apparent metastatic disease in the spine has increased since advances in tumor treatment generally have improved the life expectancy of cancer patients [10,15]. Local tumor progression can lead to vertebral body collapse with decompensation of the sagittal profile, causing pain and neurological deficits [10,15,16].…”

“…The incidence of clinically apparent metastatic disease in the spine has increased since advances in tumor treatment generally have improved the life expectancy of cancer patients [10,15]. Local tumor progression can lead to vertebral body collapse with decompensation of the sagittal profile, causing pain and neurological deficits [10,15,16]. Surgical treatment options are mainly palliative and adapted to the patients’ general condition, aiming for minimal peri- and postoperative morbidity [10,15].…”

“…Local tumor progression can lead to vertebral body collapse with decompensation of the sagittal profile, causing pain and neurological deficits [10,15,16]. Surgical treatment options are mainly palliative and adapted to the patients’ general condition, aiming for minimal peri- and postoperative morbidity [10,15]. However, more radical treatment options with removal of spinal lesions showed better results in patients with good prognosis [17,18,19,20].…”

“…In tumor patients, general condition and life expectancy have to be taken into account. Patients with prolonged life expectancy (>12 months) are recommended to be treated with a 360° instrumentation [15,17,18,19,20]. To provide sufficient rotational stability and load-bearing capacity, the vast majority of common VBRs are manufactured from different metallic alloys, preferably titanium.…”