Treatment Strategy for Metastatic Spinal Tumors: A Narrative Review

Abstract

Metastatic spinal tumors are common, and their rising incidence can be attributed to the expanding aging population and increased survival rates among cancer patients. The decision-making process in the treatment of spinal metastasis requires a multidisciplinary approach that includes medical and radiation oncology, surgery, and rehabilitation. Various decision-making systems have been proposed in the literature in order to estimate survival and suggest appropriate treatment options for patients experiencing spinal metastasis. However, recent advances in treatment modalities for spinal metastasis, such as stereotactic radiosurgery and minimally invasive surgical techniques, have reshaped clinical practices concerning patients with spinal metastasis, making a demand for further improvements on current decision-making systems. In this review, recent improvements in treatment modalities and the evolution of decision-making systems for metastatic spinal tumors are discussed.

Risk Factors Associated with Postoperative Infection in Cancer Patients Undergoing Spine Surgery

“…Surgical site infection is the main postoperative complication of spine surgery, and these infections lead to high levels of morbidity, high levels of mortality, and high costs for the health care system (8)(9)(10). In the present study, the incidence of surgical site infection was 20.37%, which is consistent with the findings of similar studies (5,13). Several risk factors are associated with a higher incidence of postoperative infection including obesity, diabetes mellitus, multiple comorbidities, smoking, a poor nutritional condition, pre-operative radiotherapy, levels of instrumentation, and surgical time (3,4,6,14,15).…”

“…The spine is the third most common site of metastasis after the lung and liver. With the advancement of therapeutic options and survival improvement among cancer patients, the need for surgical procedures for metastatic cancers in the spine is increasing, and thus, the number of postoperative complications is also increasing (13). Surgical site infection is the main postoperative complication of spine surgery, and these infections lead to high levels of morbidity, high levels of mortality, and high costs for the health care system (8)(9)(10).…”

Freehand Minimally Invasive Pedicle Screw Fixation and Minimally Invasive Decompression for a Thoracic or Lumbar Vertebral Metastatic Tumor From Hepatocellular Carcinoma

“…However, PVP alone is not optimal for spinal metastatic tumors accompanied with symptoms of neurologic compression, as neurological function cannot be improved by PVP without decompression ( 8 ). Therefore, neurological decompression and spinal tumor resection combined with internal fixation should be performed either from an anterior, posterior, or combined approach ( 9 , 10 ).…”

The Effect of Adding Biological Factors to the Decision-Making Process for Spinal Metastasis of Non-Small Cell Lung Cancer

“…These models are based on the prognostic factors significantly associated with patient survival in multivariate logistic or proportional hazards regression analyses [ 8 ]. Among these factors, the anatomical site for a primary cancer is the most significant prognostic factor, and is included in all models [ 9 ]. However, recent advances in tumor genetics suggest that a simple stratification of primary cancer by the anatomical site is insufficient [ 10 ].…”