Diagnosis and management of metastatic spine disease

A review

Daniel M. Sciubba M.D. 1 , Rory J. Petteys M.D. 1 , Mark B. Dekutoski M.D. 2 , Charles G. Fisher M.D., M.P.H., F.R.C.S.C. 3 , Michael G. Fehlings M.D., Ph.D., F.R.C.S.C. 4 , Stephen L. Ondra M.D. 5 , Laurence D. Rhines M.D. 6 , and Ziya L. Gokaslan M.D. 1
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  • 1 Departments of Neurosurgery, Johns Hopkins University, Baltimore, Maryland;
  • 4 University of Toronto, Ontario, Canada;
  • 5 Northwestern University, Chicago, Illinois; and
  • 6 The University of Texas M.D. Anderson Cancer Center, Houston, Texas; and
  • 2 Departments of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota; and
  • 3 Combined Neurosurgical & Orthopaedic Spine Program, University of British Columbia, Vancouver, Canada
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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.

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Contributor Notes

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.
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