Treatment of neoplastic spinal cord compression

Abstract

Currently, external radiation and steroid therapy are used in most patients with neoplastic spinal cord compression. Surgery is generally used to treat those who do not respond to radiation therapy. To determine the role of de novo surgery in patients with spinal metastases, a prospective study was undertaken. Over a 4 1/2-year period, the cases of 54 patients with radiologically documented spinal metastases were studied. The sites of tumor origin included soft tissue sarcoma (8 patients), kidney (6 patients), lung (5 patients), breast (5 patients), spine (6 patients), unknown primary site (6 patients), and others (18 patients). Sites of compression included the cervical spine segments in 15 patients, thoracic segments in 23, lumbar in 14, and sacral in 2. Before surgery, 24 patients (44%) were nonambulatory. Three surgical approaches were used: anterior vertebral body resection in 45 patients, laminectomy in 7, and lateral osteotomy in 2. After surgery, 37 patients received external radiation therapy. All patients improved (became ambulatory) after surgery, with 23 of 25 patients surviving at 2 years continuing to be ambulatory. The 30-day mortality rate was 6% (three patients); eight patients (15%) sustained various surgical complications. These results are superior to those reported after external radiation therapy and steroids alone, and they support the concept that de novo surgery be considered in selected patients with spinal metastases.

Stereotactic Body Radiosurgery for Spinal Metastatic Disease: An Evidence-Based Review

“…While conventional radiation therapy delivered without the use of high-precision localization techniques has been used for decades [6, 7, 55, 56], over the past fifteen years, new radiotherapy technologies now enable the delivery of high doses of focal radiation therapy with steep dose fall-off and millimeter accuracy in sites other than the brain. The safety and efficacy of these new technologies for use in spinal tumors have been increasingly demonstrated.…”

Physiopathology of Spine Metastasis

“…The spine is the most common site of bone metastasis [2, 12]. It is estimated that over the 10% of patients with cancer will develop a symptomatic spinal metastasis [19, 20]. Algra et al suggest that the initial anatomic location of metastases within vertebrae is in the posterior portion of the body.…”

Interobserver agreement for the spine instability neoplastic score varies according to the experience of the evaluator

“…In up to 20% of patients, the symptoms related to vertebral metastases are the initial manifestation of cancer (1). Vertebral metastases can cause severe complications, including compression of the spinal cord, which is found in 5-14% of patients with cancer over the course of the disease (2,3). The spinal cord compression may result from the growth of the tumor mass in the epidural space or may be associated with pathological fracture of the vertebra, which leads to compression by bone fragments or mechanical instability secondary to fracture (4,5).…”