Diagnosis and management of metastatic spine disease

A review

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With continued growth of the elderly population and improvements in cancer therapies, the number of patients with symptomatic spinal metastases is likely to increase, and this is a condition that commonly leads to debilitating neurological dysfunction and pain. Advancements in surgical techniques of resection and spinal reconstruction, improvements in clinical outcomes following various treatment modalities, generally increased overall survival in patients with metastatic spine disease, and a recent randomized trial by Patchell and colleagues demonstrating the superiority of a combined surgical/radiotherapeutic approach over a radiotherapy-only strategy have led many to suggest increasingly aggressive interventions for patients with such lesions. Optimal management of spinal metastases encompasses numerous medical specialties, including neurosurgery, orthopedic surgery, medical and radiation oncology, radiology, and rehabilitation medicine. In this review, the clinical presentation, diagnosis, and management of spinal metastatic disease are discussed. Ultimately, the goal of treatment in patients with spinal metastases remains palliative, and clinical judgment is required to select the appropriate patients for surgical intervention.

Abbreviations used in this paper: ISCM = intramedullary spinal cord metastasis; MESCC = metastatic epidural spinal cord compression; PMMA = polymethylmethacrylate; SRS = stereotactic radiosurgery; VB = vertebral body; XRT = radiation therapy.

Article Information

Address correspondence to: Daniel M. Sciubba, M.D., Department of Neurosurgery, Johns Hopkins University School of Medicine, Meyer 7-109, 600 North Wolfe Street, Baltimore, Maryland 21287. email: dsciubb1@jhmi.edu.

© AANS, except where prohibited by US copyright law.

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Figures

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    A: Intraoperative photograph of thoracic spondylectomy and anterior reconstruction with distractible titanium cage and posterior pedicle screw stabilization. B: Postoperative anteroposterior radiograph of thoracic spondylectomy and anterior reconstruction with distractible titanium cage and posterior pedicle screw stabilization. C: Postoperative coronal CT scan of thoracic spondylectomy and anterior reconstruction with distractible titanium cage and posterior pedicle screw stabilization. D: Postoperative lateral radiograph of thoracic spondylectomy and anterior reconstruction with distractible titanium cage and posterior pedicle screw stabilization.

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    Flowchart for the management of spinal metastases.

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