Evaluation and Management of Spinal Axis Tumors

Top Ten Tips Palliative Care Clinicians Should Know About Spinal Tumors

“…Mechanical pain from damaged vertebra and instability increases with standing or activity and improves when the patient lies down. 7 Mechanical pain is a strong predictor of instability and warrants surgical consultation. Tumorrelated medically refractory pain also should warrant surgical consultation.…”

“…Symptoms can be divided into radicular (those that effect a particular nerve pattern with singular muscle group weakness, dermatomal numbness) and/or myelopathy (gait instability, spasticity, weakness, sensory loss, and bowel and bladder dysfunction). 7 Quick onset symptoms of spinal cord compression are a neurological emergency and warrant stat imaging with a spinal MRI with and without contrast. While all tumors with epidural compression should be considered for surgical FIG.…”

“…The procedure is contraindicated in patients with tumor extension into the posterior elements, significant epidural disease, or disruption of the posterior wall of the vertebral body cortex because cement could extravasate into the spinal canal and cause spinal cord compression. 7 MRI is useful in the preoperative evaluation of these patients to evaluate the posterior elements, extent of epidural disease, and the degree of vertebral body height loss. Radiofrequency ablation, which uses a heat-generated current to destroy tumor tissue, can also be performed percutaneously and is coupled with kyphoplasty/vertebroplasty to treat metastatic disease.…”

“…Additionally, radiotherapy alone is preferred for patients that cannot tolerate surgery or have a poor prognosis (less than three months). 7 Despite the tumorablative effects of radiation treatment alone, patients may warrant evaluation for resultant spinal instability (measured by SINS criteria) from 30 to 180 days post-radiation, particularly with single-fraction palliative radiation. 16…”

“…Coupled with subsequent studies, the Patchell study showed that patients managed with surgery and radiation had better outcomes, including the ability to ambulate post-surgery than patients managed with radiation alone. 7,17 Of note, the patients included in this study had an expected post-intervention survival of three months or greater. Scales measuring motor function, such as the Frankel scale can demonstrate improvement post-operatively in appropriately selected patients.…”