Risk Factors for Pathological Fracture and Metastatic Epidural Spinal Cord Compression in Patients With Spinal Metastases

Abstract

Vertebral pathological fracture and metastatic epidural spinal cord compression (MESCC) due to metastatic cancer inevitably cause pain, neurological deficit, impaired function, and decreased quality of life and are indications for surgery. In such cases, earlier surgical intervention has the potential to prevent permanent neurological deficit and disability and to maintain function and quality of life. Therefore, the aim of this study was to identify and evaluate risk factors for pathological fracture and MESCC in patients with spinal metastases. Retrospective assessment of clinical and radiological parameters was undertaken in patients with spinal metastases. Seventy-two patients with spinal metastases underwent decompressive and/or stabilization surgery for pathological fracture and/or MESCC or nerve root compression. The following items were assessed for association with pathological fracture or MESCC: tumor size, location, type, and morphology; disease burden; pain; and function. Pain, tumor size within the vertebral body, vertebral endplate and 3-column involvement, primary tumor growth rate, and multiple vertebral metastases were associated with increased risk for pathological fracture. Vertebral posterior element and costovertebral joint involvement by tumor, primary tumor growth rate, and the presence of visceral metastases were associated with MESCC or nerve root compression. These factors should be considered in the decision-making process for surgery for spinal metastases. Patients with osteolytic spinal metastatic lesions causing pain, greater than 25% occupancy of the vertebral body, and involvement of the vertebral endplate or all 3 columns should be considered for prophylactic or therapeutic decompressive and stabilization surgery. [Orthopedics. 2018; 41(1):e38-e45.].

Accuracy of Preoperative Scoring Systems for the Prognostication and Treatment of Patients with Spinal Metastases

“…This work formed part of a thesis for Master of Surgery (by Research), University of Melbourne [ 27 ].…”

The Role of Diffusion-Weighted Mri of Patients With Spine Metastases

“…16,17 A significant negative correlation between ADC values and the Ki-67 researchers recommend prophylactic or therapeutic decompressive and stabilization surgery in patients with osteolytic spinal metastases with lesions more than 25% of the vertebral body and involvement of the vertebral end plates of the vertebral bodies or all three vertebral discs. 5 In rare cases, surgical decompression of the spinal cord in the context of metastatic tumors is complicated by neurological disorders and neurological complications, which occur mainly during the resection of tumors located in the thoracic spine. 9 Surgical treatment is indicated for patients with an estimated life expectancy of more than 3 months, and should provide them the optimum quality of life.…”

“…Researchers have reported, in particular, on the possibility of integrating a 1.5T MRI scanner with a linear accelerator. 4,5 Multislice computed tomography (MSCT) enables the identification of areas of lytic destruction of the vertebrae with violation of the integrity of the cortical layer and soft-tissue component in the paravertebral soft tissues or spinal canal with bolus contrast enhancement. A bone scan is a screening technique that reveals the presence of metastases in the bones.…”

Role of magnetic resonance imaging in the differential diagnosis of spinal signal changes caused by infection and tumor in the early stages

“…In the process of metastatic invasion, the load-bearing time of the lesion is long, so compression occurs relatively early and is more marked. At the same time, it can be accompanied by enlargement and deformation of involved vertebral appendages [16] . Second, compression of the spinal canal, spinal cord, and nerve root can be observed.…”