Surgical Treatment of Metastatic Spinal Tumors (original) (raw)
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Surgical Management of Spinal Metastases
The Oncologist, 2004
Metastatic spread to the spinal column is a growing problem in patients with cancer. It can cause a number of sequelae including pain, instability, and neurologic deficit. If left untreated, progressive myelopathy results in the loss of motor, sensory, and autonomic functions. Except in rare circumstances, treatment is palliative. Traditionally, conventional fractionated external beam radiotherapy has been the treatment of choice. "Surgery" for metastatic spinal disease was, and generally continues to be, equated with laminectomy by many physicians. However, there has been a remarkable evolution in surgical techniques over the last 20 years. Today, the goal of surgery is to achieve circumferential decompression of the neural elements while reconstructing and immediately stabilizing the spinal column. This has been made possible by the use of different surgical approaches and the exploitation of a burgeoning array of internal fixation devices. More recently, minimally invasive surgical techniques, such as endoscopy, kyphoplasty/vertebroplasty, and stereotactic radiosurgery, have been added to the surgeon's armamentarium. As the number of treatment options for metastatic spinal disease grows, it has become clear that effective implementation of treatment can only be achieved by a multidisciplinary approach. This will provide the surest means of maximizing the quality of the remainder of the patient's life. . Multiple lesions at noncontiguous levels occur in 10%-40% of cases .
Percutaneous Treatment of the Spinal Metastases
Journal of Spine, 2012
The spinal column is the most frequent site of bone metastases, and between 30% and 70% of patients with cancer will have evidence of spinal metastasis at autopsy . The majority of metastasis occurs in the thoracic spine (70%) followed by the lumbar (20%) and cervical region (10%), . The surgical treatment of the vertebral metastases remains a real challenge in spine surgeons. Recent advancements in surgical techniques allow a less aggressive approach of the patient with better results in terms of decreasing pain, improvement of the quality of life. We must avoid the overtreatment of terminally ill patients; some patients may survive for several years and benefit from surgery.
Minimally Invasive Management of Spinal Metastases
Orthopedic Clinics of North America, 2009
The surgical treatments of spinal metastases remain controversial. Many local and systemic factors have to be considered in the treatment of metastatic lesions of the spine, including tumor type, extent of metastatic disease in the spine and the body, stability of the spine, neurologic status, comorbid conditions, and life expectancy of the patient. The standard open operations are suitable for patients in healthier conditions and with a longer life expectancy. The en bloc resections of solitary metastases of certain cancer types (kidney, breast, and thyroid) require conventional approaches. In most patients, the treatment is largely palliative and aims to achieve relief of pain and to regain function, thus improving the quality of the life of the patient as quickly as possible. Because of their immunocompromised status from ongoing chemotherapy, poor nutrition, and comorbid medical conditions, these patients cannot tolerate the conventional surgical methods. Minimally invasive spinal interventions are reasonable alternatives to treat spinal metastatic disease. These procedures can result in less soft tissue trauma, lower blood loss, and shorter hospitalization time. These methods rarely interfere with the adjuvant treatments. The overall morbidity is considerably lower in comparison to conventional spine surgery.
Neurological Outcome Following Surgical Treatment of Spinal Metastases
Egyptian Spine Journal
Background Data: Spinal metastases lead to bony instability and spinal cord compression resulting in intractable pain and neurological deficits which affects ambulatory function and quality of life, the most appropriate treatment for spinal metastasis is still debated. Purpose: The aim of this study to evaluate clinical, quality of life, complications and survival outcomes after surgical treatment of spinal metastases. Design: It is a retrospective study. Patients and Methods: Retrospective review of patients with spinal metastases surgically treated at our facility between March 2008 and March 2013 was performed. Evaluations include hospital charts, initial and interval imaging studies, neurological outcome and surgical complications, Follow-up examinations were performed every three months after surgery Results: 70 patients underwent surgical intervention for treatment of spinal metastasis in our institution. There were 27 women and 43 men. Preoperative pain was reported in 65 patients (93%), whereas postoperative complete pain relief was reported in 16 patients (24%) and pain levels decreased in 38 patients (58%). Preoperative 39 patients were ambulant and 31 patients were non-ambulant. Postoperative 52 patients were ambulant and 18 patients were non-ambulant. Postoperative complications were experienced in 10 (14.2%) patients, the patient survival rate was 71% (50 patients) at 3 months, 49 %(34 patients) at 1 year. The postoperative 30-day mortality rate was 4.2%. Conclusion: Surgical decompression for metastatic spinal tumor can improve quality of life in a substantially high percentage of patients with acceptable complications rate. (2015ESJ080)
Background: This study attempted to review the medical records of all patients with spinal bone metastases presented to Alexandria Clinical Oncology and Nuclear Medicine Department (ACOD), Alexandria Main University Hospital during the period from January 2003 to December 2012. Patients and Methods: A total of 350 patients were included in this study. Medical records were retrospectively reviewed and data were collected as regard demographic data, medical history, Clinical data, Investigations and diagnostic work up, treatment modalities and treatment outcomes. Results: we observed that the origin of the tumor in the majority of cases was breast cancer (31.1%), followed by prostate cancer 17.7% then multiple myeloma 17.1%.The female patients presented with the highest percentage 60.9%.performance status according Eastern Cooperative Oncology Group (ECOG) score was 0-2 in 58% of patients. The majority of patients were complaining of pain (98.6%). A considerable percentage of cases presented with symptoms of spinal cord compression (30%). Improvement regarding pain after treatment with radiotherapy was reported in (42.6%) of patients. Motor function improvement was (89.7%) at 8 weeks for patients presented with paresis and treated early. Type of primary tumor was the most significant prognostic factor (HR=6.873 and 4.431, P <0.001). Conclusions: Breast cancer, prostate cancer and multiple myeloma constituted the most common primaries that develop spinal metastases. A higher incidence of spinal metastases in women compared with men. The predominant symptom in patients with spinal metastases was pain. Patients who developed spinal metastases were at risk of spinal cord compression. The goals of treatment were to relieve pain and prevent complications. External beam radiotherapy has been the mainstay for palliating pain resulting from spinal metastases. Early initiation of radiotherapy promote better functional outcome. Type of primary tumor was identified as the most powerful prognostic factor for patients with spinal metastases.
Management of metastatic spinal column neoplasms--an update
Revista do Colégio Brasileiro de Cirurgiões
The increased survival of cancer patients due to the improvement and advancement of therapeutic modalities has promoted progressive increase in the prevalence of metastatic tumors of the spine, making it important for healthcare professionals to acquire knowledge in the field. Spinal column metastases are usually secondary to malignant neoplasm of the breast, lung and prostate, male gender being the most often affected and pain being the initial symptom in 90% of patients. It is estimated that 30-90% of terminally ill patients with cancer have metastases at some spinal column segment. Clinical history, physical and neurological assessments are critical to determine the degree and extent of the lesion, and therefore choose the appropriate imaging method to be requested. This study aims to perform a review and didactic description of the main aspects related to the physiopathology, diagnosis and treatment of this disease.
Holistic Approach to the Diagnosis and Treatment of Patients with Tumor Metastases to the Spine
Cancers
The treatment of neoplastic spine metastases requires multi-faceted assessment and an interdisciplinary approach to patients. The metastases do not show specific symptoms but are often the first confirmation of the presence of a primary tumor in a patient. The diagnostic process includes imaging and invasive procedures, e.g., biopsy. It is essential to qualify the patient for an appropriate treatment using dedicated scales. Decompression of the spinal cord is a critical issue to save or restore neurological function in a patient with spine metastases. Surgical treatment ought to meet three criteria: release spinal cord and nerve roots, restore the spine’s anatomical relations, and ensure the internal stabilization of the spine. A good result from surgical treatment enables the continuation of radiotherapy, chemotherapy, hormone therapy, and targeted molecular therapy. Stereotactic radiosurgery and stereotactic body radiotherapy are more effective ways of treating spine metastases th...
Metastatic Spinal Tumor -Updated Therapeutic Approach
Metastases spinal tumor represent a challenging problem in an oncology practice, 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.
Management of metastatic spine disease
Current Opinion in Supportive & Palliative Care, 2010
Purpose of review In metastatic spine disease, technologic advancements, neurologic recovery, pain relief, cost-effectiveness, and health-related quality of life have all strengthened surgery's and radiation's role in its management. We evaluated different surgical approaches to the spine and the multimodality treatment in the management of these cases. Recent findings Recently, the survival rate of malignant spinal metastases has rapidly improved because of early detection and multimodality treatment. The goals of surgical intervention are to prolong survival and improve the quality of life of patients. The recent evolution of imaging, radiosurgery, advanced surgical decompressive techniques and instrumentation, as well as percutaneous vertebral body cement augmentation, needs to be considered in the decision-making to optimize patient outcomes. Summary Management of patients with spine tumors requires a multidisciplinary team that includes a medical and radiation oncologist and a spine surgeon. Newer surgical techniques that address both tumor resection and spinal stabilization offer the best outcome in selected patients. The prognostic parameters suggested for metastatic spine tumors include the general condition of the patient, neurological status number of spinal and extraspinal metastases, primary site of the cancer, visceral metastasis, and severity of spinal cord compression.