Surgical Management of Spinal Metastases

Abstract

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.

Metástases do segmento torácico e lombar da coluna vertebral: estudo prospectivo comparativo entre o tratamento cirúrgico e radioterápico com a imobilização externa e radioterapia

“…As metástases, no nosso estudo, se originaram mais freqüentemente de tumores localizados no pulmão e mama, o que confere com os achados da literatura 1,3,4 . A localização mais freqüente em nossos pacientes foram na transição toracolombar seguido pelo segmento torácico, sendo o inverso observado na literatura 1 .…”

“…A compressão nervosa é a principal complicação das metástases toracolombares, sendo evidenciada em cerca de 20% dos pacientes 2 . As metástases toracolombares são usualmente originadas do tumor primário de localização na mama, prósta-ta e pulmão 1,3,4 . Estas lesões ocasionam prejuízo na qualidade de vida do paciente pela dor conseqüen-te à instabilidade mecânica e aos distúrbios neurológicos 3 .…”

“…durante o tratamento radioterápico, o exame neurológico seriado deve ser realizado, sendo a deterioração neurológica indicativa de falha terapêutica 4,9,10 . O tratamento cirúrgico é indicado nesses casos, porém 77% dos pacientes não recuperam a função perdida 4,9,10 .…”

Management of metastatic sacral tumours

“…Despite the fact that older publications demonstrated that radiotherapy alone could be as effective as a combination of decompressive surgery with adjuvant radiotherapy [51][52][53], more recent studies have shown that decompressive surgery with/out reconstruction and stabilisation followed by postoperative radiotherapy was superior than radiotherapy alone [54,55].…”

Comparison of four techniques for spine stereotactic body radiotherapy: Dosimetric and efficiency analysis

“…Up to 40% of these patients have spinal metastasis 1. Various techniques, including dose‐escalated radiotherapy, have been utilized to improve local control and symptom palliation 2, 3, 4, 5.…”