Skip to main content
SpringerLink
Log in

Evaluation and Treatment of Spinal Metastatic Disease

  • Chapter
  • First Online:
Orthopaedic Oncology

Part of the book series: Cancer Treatment and Research ((CTAR,volume 162))

Abstract

With the increased survival of oncologic patients, evaluation and management of patients with spinal metastasis is crucial to reducing morbidity and maximizing function. In this chapter, we present some guidelines for the initial systematic evaluation of patients with spinal lesions, as well as the risks, benefits, and alternatives to nonoperative and operative management of metastatic spinal disease, and the overall survival of these patients.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. American Cancer Society (2013) Cancer Facts & Figures 2013. http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-036845.pdf. Accessed June 6 2013

  2. American Association of Neurologic Surgeons (2013) Patient Information. http://www.aans.org/en/Patient%20Information/Conditions%20and%20Treatments/Spinal%20Tumors.aspx. Accessed June 6 2013

  3. Rougraff BT, Kneisl JS, Simon MA (1993) Skeletal metastases of unknown origin. A prospective study of a diagnostic strategy. J Bone Joint Surg Am 75(9):1276–1281

    CAS  PubMed  Google Scholar 

  4. Sundaresan N, Digiacinto GV, Hughes JE, Cafferty M, Vallejo A (1991) Treatment of neoplastic spinal cord compression: results of a prospective study. Neurosurgery 29(5):645–650

    Article  CAS  PubMed  Google Scholar 

  5. Byrne TN, Benzel EC, Waxman SG (2000) Epidural tumors. In: Byrne TN, Benzel EC, Waxman SG (eds) Diseases of the spine and the spinal cord. Oxford University Press, New York, pp 166–205

    Google Scholar 

  6. Jaffe HL (1968) Tumors metastatic to the skeleton. In: Jaffe HL (ed) Tumors and tumorous conditions of the bones and joints. Lea and Febiger, Philadelphia, pp 589–618

    Google Scholar 

  7. Barron KD, Hirano A, Araki S, Terry RD (1959) Experiences with metastatic neoplasms involving the spinal cord. Neurology 9(2):91–106

    Article  CAS  PubMed  Google Scholar 

  8. Clarke E (1956) Spinal cord involvement in multiple myelomatosis. Brain 79(2):332–348

    Article  CAS  PubMed  Google Scholar 

  9. Galasko CS (1972) Skeletal metastases and mammary cancer. Ann R Coll Surg Engl 50(1):3–28

    CAS  PubMed Central  PubMed  Google Scholar 

  10. Nathoo N, Caris EC, Wiener JA, Mendel E (2011) History of the vertebral venous plexus and the significant contributions of Breschet and Batson. Neurosurgery 69(5):1007–1014; discussion 1014

    Google Scholar 

  11. Rougraff BT (2003) Evaluation of the patient with carcinoma of unknown origin metastatic to bone. Clin Orthop Relat Res 415(415 Suppl):S105–S109

    Article  PubMed  Google Scholar 

  12. Perrin RG, Laxton AW (2004) Metastatic spine disease: epidemiology, pathophysiology, and evaluation of patients. Neurosurg Clin N Am 15(4):365–373

    Article  PubMed  Google Scholar 

  13. Metser U, Lerman H, Blank A, Lievshitz G, Bokstein F, Even-Sapir E (2004) Malignant involvement of the spine: assessment by 18F-FDG PET/CT. J Nucl Med 45(2):279–284

    PubMed  Google Scholar 

  14. Shah LM, Salzman KL (2011) Imaging of spinal metastatic disease. Int J Surg Oncol (Article ID 769753)

    Google Scholar 

  15. Saghieh S, Masrouha KZ, Musallam KM et al (2010) The risk of local recurrence along the core-needle biopsy tract in patients with bone sarcomas. Iowa Orthop J 30:80–83

    PubMed Central  PubMed  Google Scholar 

  16. Prabhu VC, Bilsky MH, Jambhekar K et al (2003) Results of preoperative embolization for metastatic spinal neoplasms. J Neurosurg 98(2 Suppl):156–164

    PubMed  Google Scholar 

  17. Polley P, Dunn R (2009) Noncontiguous spinal tuberculosis: incidence and management. Eur Spine J 18(8):1096–1101

    Article  PubMed Central  PubMed  Google Scholar 

  18. Gupta A, el Masri WS (1989) Multilevel spinal injuries. Incidence, distribution and neurological patterns. J Bone Joint Surg Br 71(4):692–695

    CAS  PubMed  Google Scholar 

  19. Salvo N, Christakis M, Rubenstein J et al (2009) The role of plain radiographs in management of bone metastases. J Palliat Med 12(2):195–198

    Article  PubMed  Google Scholar 

  20. Buhmann Kirchhoff S, Becker C, Duerr HR, Reiser M, Baur-Melnyk A (2009) Detection of osseous metastases of the spine: comparison of high resolution multi-detector-CT with MRI. Eur J Radiol 69(3):567–573

    Google Scholar 

  21. Boriani S, Weinstein JN, Biagini R (1997) Primary bone tumors of the spine. Terminology and surgical staging. Spine (Phila Pa 1976) 22(9):1036–1044

    Google Scholar 

  22. Tokuhashi Y, Ajiro Y, Umezawa N (2009) Outcome of treatment for spinal metastases using scoring system for preoperative evaluation of prognosis. Spine (Phila Pa 1976) 34(1):69–73

    Google Scholar 

  23. Loblaw DA, Laperriere NJ (1998) Emergency treatment of malignant extradural spinal cord compression: an evidence-based guideline. J Clin Oncol 16(4):1613–1624

    CAS  PubMed  Google Scholar 

  24. Ross JR, Saunders Y, Edmonds PM, Patel S, Broadley KE, Johnston SR (2003) Systematic review of role of bisphosphonates on skeletal morbidity in metastatic cancer. Bmj 327(7413):469

    Google Scholar 

  25. Huang RC, Khan SN, Sandhu HS et al (2005) Alendronate inhibits spine fusion in a rat model. Spine (Phila Pa 1976) 30(22):2516–2522

    Google Scholar 

  26. Lehman RA Jr, Kuklo TR, Freedman BA, Cowart JR, Mense MG, Riew KD (2004) The effect of alendronate sodium on spinal fusion: a rabbit model. Spine J 4(1):36–43

    Article  PubMed  Google Scholar 

  27. Nagahama K, Kanayama M, Togawa D, Hashimoto T, Minami A (2011) Does alendronate disturb the healing process of posterior lumbar interbody fusion? A prospective randomized trial. J Neurosurg Spine 14(4):500–507

    Article  PubMed  Google Scholar 

  28. Nakao S, Minamide A, Kawakami M, Boden SD, Yoshida M (2011) The influence of alendronate on spine fusion in an osteoporotic animal model. Spine (Phila Pa 1976) 36(18):1446–1452

    Google Scholar 

  29. Hartsell WF, Scott CB, Bruner DW et al (2005) Randomized trial of short- versus long-course radiotherapy for palliation of painful bone metastases. J Natl Cancer Inst 97(11):798–804

    Article  PubMed  Google Scholar 

  30. Gy single fraction radiotherapy for the treatment of metastatic skeletal pain: randomised comparison with a multifraction schedule over 12 months of patient follow-up (1999) Bone Pain Trial Working Party. Radiother Oncol 52(2):111–121

    Google Scholar 

  31. Patchell RA, Tibbs PA, Regine WF et al (2005) Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet 366(9486):643–648

    Google Scholar 

  32. Laufer I, Iorgulescu JB, Chapman T et al (2013) Local disease control for spinal metastases following “separation surgery” and adjuvant hypofractionated or high-dose single-fraction stereotactic radiosurgery: outcome analysis in 186 patients. J Neurosurg Spine 18(3):207–214

    Article  PubMed  Google Scholar 

  33. Moulding HD, Elder JB, Lis E et al (2010) Local disease control after decompressive surgery and adjuvant high-dose single-fraction radiosurgery for spine metastases. J Neurosurg Spine 13(1):87–93

    Article  PubMed  Google Scholar 

  34. Laufer I, Rubin DG, Lis E et al (2013) The NOMS framework: approach to the treatment of spinal metastatic tumors. Oncologist 18(6):744–751

    Article  PubMed Central  PubMed  Google Scholar 

  35. Bilsky M, Smith M (2006) Surgical approach to epidural spinal cord compression. Hematol Oncol Clin North Am 20(6):1307–1317

    Article  PubMed  Google Scholar 

  36. Fisher CG, DiPaola CP, Ryken TC et al (2010) A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group. Spine (Phila Pa 1976) 35(22):E1221–1229

    Google Scholar 

  37. Klimo P Jr, Kestle JR, Schmidt MH (2004) Clinical trials and evidence-based medicine for metastatic spine disease. Neurosurg Clin N Am 15(4):549–564

    Article  PubMed  Google Scholar 

  38. Young RF, Post EM, King GA (1980) Treatment of spinal epidural metastases. Randomized prospective comparison of laminectomy and radiotherapy. J Neurosurg 53(6):741–748

    Article  CAS  PubMed  Google Scholar 

  39. Klein JD, Hey LA, Yu CS et al (1996) Perioperative nutrition and postoperative complications in patients undergoing spinal surgery. Spine (Phila Pa 1976) 21(22):2676–2682

    Google Scholar 

  40. Hu SS, Fontaine F, Kelly B, Bradford DS (1998) Nutritional depletion in staged spinal reconstructive surgery. The effect of total parenteral nutrition. Spine (Phila Pa 1976) 23(12):1401–1405

    Google Scholar 

  41. Lapp MA, Bridwell KH, Lenke LG, Baldus C, Blanke K, Iffrig TM (2001) Prospective randomization of parenteral hyperalimentation for long fusions with spinal deformity: its effect on complications and recovery from postoperative malnutrition. Spine (Phila Pa 1976) 26(7):809–817; discussion 817

    Google Scholar 

  42. Halpin RJ, Sugrue PA, Gould RW et al (2010) Standardizing care for high-risk patients in spine surgery: the Northwestern high-risk spine protocol. Spine (Phila Pa 1976) 35(25):2232–2238

    Google Scholar 

  43. Savage JW, Anderson PA (2013) An update on modifiable factors to reduce the risk of surgical site infections. Spine J 24(13):00401–00405

    Google Scholar 

  44. Harrington KD (1993) Metastatic tumors of the spine: diagnosis and treatment. J Am Acad Orthop Surg 1(2):76–86

    Google Scholar 

  45. Nader R, Alford BT, Nauta HJ, Crow W, vanSonnenberg E, Hadjepavlou AG (2002) Preoperative embolization and intraoperative cryocoagulation as adjuncts in resection of hypervascular lesions of the thoracolumbar spine. J Neurosurg 97(3 Suppl):294–300

    Google Scholar 

  46. Rehak S, Krajina A, Ungermann L et al (2008) The role of embolization in radical surgery of renal cell carcinoma spinal metastases. Acta Neurochir (Wien) 150(11):1177–1181; discussion 1181

    Google Scholar 

  47. Manke C, Bretschneider T, Lenhart M et al (2001) Spinal metastases from renal cell carcinoma: effect of preoperative particle embolization on intraoperative blood loss. AJNR Am J Neuroradiol 22(5):997–1003

    CAS  PubMed  Google Scholar 

  48. Broaddus WC, Grady MS, Delashaw JB Jr, Ferguson RD, Jane JA (1990) Preoperative superselective arteriolar embolization: a new approach to enhance resectability of spinal tumors. Neurosurgery. 27(5):755–759

    Article  CAS  PubMed  Google Scholar 

  49. Berkefeld J, Scale D, Kirchner J, Heinrich T, Kollath J (1999) Hypervascular spinal tumors: influence of the embolization technique on perioperative hemorrhage. AJNR Am J Neuroradiol 20(5):757–763

    CAS  PubMed  Google Scholar 

  50. Finstein JL, Chin KR, Alvandi F, Lackman RD (2006) Postembolization paralysis in a man with a thoracolumbar giant cell tumor. Clin Orthop Relat Res 453:335–340

    Article  PubMed  Google Scholar 

  51. Truumees E, Dodwad SN, Kazmierczak CD (2010) Preoperative embolization in the treatment of spinal metastasis. J Am Acad Orthop Surg 18(8):449–453

    PubMed  Google Scholar 

  52. Taniguchi T, Ohta K, Ohmura S, Yamamoto K, Kobayashi T (2000) Perioperative management for total en bloc spondylectomy–the effects of preoperative embolization and hypotensive anesthesia. Masui 49(2):168–171

    CAS  PubMed  Google Scholar 

  53. Wirbel RJ, Roth R, Schulte M, Kramann B, Mutschler W (2005) Preoperative embolization in spinal and pelvic metastases. J Orthop Sci 10(3):253–257

    Article  PubMed  Google Scholar 

  54. Mani RL, Eisenberg RL (1978) Complications of catheter cerebral arteriography: analysis of 5,000 procedures. II. Relation of complication rates to clinical and arteriographic diagnoses. AJR Am J Roentgenol 131(5):867–869

    Article  CAS  PubMed  Google Scholar 

  55. Bradac GB, Oberson R (1980) CT and angiography in cases with occlusive disease of supratentorial cerebral vessels. Neuroradiology 19(4):193–200

    Article  CAS  PubMed  Google Scholar 

  56. Capener N (1954) The evolution of lateral rhachotomy. J Bone Joint Surg Br 36-B(2):173–179

    Google Scholar 

  57. Larson SJ, Holst RA, Hemmy DC, Sances A Jr (1976) Lateral extracavitary approach to traumatic lesions of the thoracic and lumbar spine. J Neurosurg 45(6):628–637

    Article  CAS  PubMed  Google Scholar 

  58. Jandial R, Chen MY (2012) Modified lateral extracavitary approach for vertebral column resection and expandable cage reconstruction of thoracic spinal metastases. Surg Neurol Int 3(136):136

    PubMed Central  PubMed  Google Scholar 

  59. Dodwad SN, Khan SN (2013) Surgical stabilization of the spine in the osteoporotic patient. Orthop Clin North Am 44(2):243–249

    Article  PubMed  Google Scholar 

  60. Wai EK, Finkelstein JA, Tangente RP et al (2003) Quality of life in surgical treatment of metastatic spine disease. Spine (Phila Pa 1976) 28(5):508–512

    Google Scholar 

  61. Spivak JM, Johnson MG (2005) Percutaneous treatment of vertebral body pathology. J Am Acad Orthop Surg 13(1):6–17

    PubMed  Google Scholar 

  62. Dudeney S, Lieberman IH, Reinhardt MK, Hussein M (2002) Kyphoplasty in the treatment of osteolytic vertebral compression fractures as a result of multiple myeloma. J Clin Oncol 20(9):2382–2387

    Article  CAS  PubMed  Google Scholar 

  63. Fourney DR, Schomer DF, Nader R et al (2003) Percutaneous vertebroplasty and kyphoplasty for painful vertebral body fractures in cancer patients. J Neurosurg 98(1 Suppl):21–30

    PubMed  Google Scholar 

  64. Pflugmacher R, Kandziora F, Schroeder RJ, Melcher I, Haas NP, Klostermann CK (2006) Percutaneous balloon kyphoplasty in the treatment of pathological vertebral body fracture and deformity in multiple myeloma: a one-year follow-up. Acta Radiol 47(4):369–376

    Article  CAS  PubMed  Google Scholar 

  65. Berenson J, Pflugmacher R, Jarzem P et al (2011) Balloon kyphoplasty versus non-surgical fracture management for treatment of painful vertebral body compression fractures in patients with cancer: a multicentre, randomised controlled trial. Lancet Oncol 12(3):225–235

    Article  PubMed  Google Scholar 

  66. Hessler C, Regelsberger J, Raimund F, Heese O, Madert J, Eggers C (2008) Prognosis after surgical treatment of spinal metastases due to lung cancer. Chirurg 79(7):671–679

    Article  CAS  PubMed  Google Scholar 

  67. Wise JJ, Fischgrund JS, Herkowitz HN, Montgomery D, Kurz LT (1999) Complication, survival rates, and risk factors of surgery for metastatic disease of the spine. Spine (Phila Pa 1976) 24(18):1943–1951

    Google Scholar 

  68. Klimo P, Jr., Kestle JR, Schmidt MH (2003) Treatment of metastatic spinal epidural disease: a review of the literature. Neurosurg Focus 15(5):E1

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Northwestern Memorial Hospital, 676 N St Clair St, Suite 1350, Chicago, IL, 60611, USA

    Shah-Nawaz M. Dodwad, Jason Savage & Alpesh Patel

  2. The Ohio State University Wexner Medical Center, 410 W 10th Ave, Columbus, OH , 43210, USA

    Thomas J. Scharschmidt

Authors
  1. Shah-Nawaz M. Dodwad
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jason Savage
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thomas J. Scharschmidt
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alpesh Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alpesh Patel .

Editor information

Editors and Affiliations

  1. Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA

    Terrance D. Peabody

  2. Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA

    Samer Attar

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Dodwad, SN.M., Savage, J., Scharschmidt, T.J., Patel, A. (2014). Evaluation and Treatment of Spinal Metastatic Disease. In: Peabody, T., Attar, S. (eds) Orthopaedic Oncology. Cancer Treatment and Research, vol 162. Springer, Cham. https://doi.org/10.1007/978-3-319-07323-1_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-07323-1_7

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-07322-4

  • Online ISBN: 978-3-319-07323-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation