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Diagnosis and management of spinal metastases in rehabilitation

  • Sarah Money
  • Sean Smith
Cancer Rehabilitation (MD Stubblefield, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Cancer Rehabilitation

Abstract

Purpose of Review

To provide an overview of the presentation, diagnosis and management of spinal metastatic disease, as it relates to pain, function, and quality of life.

Recent Findings

There are a multitude of treatment options to address spinal metastatic disease, including radiotherapy, minimally invasive procedures, oral medications, and surgery. Treatment is individualized to the patient according to severity of symptoms, location of metastases, and concordant medical conditions. Patients may require treatments across several subspecialties to comprehensively treat their disease. The location and nature of metastatic disease within the spine are important, and an assessment of the patient’s neurologic status throughout treatment is essential in order to optimize patient function, to successfully manage pain when present, and to identify early potentially catastrophic changes.

Summary

It is necessary to use a multidisciplinary approach to address spinal metastatic disease, and there have been great advancements in terms of variety of available treatments.

Keywords

Spine metastases Metastatic spine pain Cancer pain Metastatic pain Cancer rehabilitation 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no competing interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

  1. 1.
    Harel R, Angelov L. Spine metastases: current treatments and future directions. Eur J Cancer. 2010;46:2696–707.CrossRefPubMedGoogle Scholar
  2. 2.
    Witham, Timothy F, et al. Surgery insight: current management of epidural spinal cord compression from metastatic spine disease. Nat Clin Pract Neurol, vol. 2.Google Scholar
  3. 3.
    Gallizia E, Apicella G, Cena T, di Genesio Pagliuca M, Deantonio L, Krengli M. The spine instability neoplastic score (SINS) in the assessment of response to radiotherapy for bone metastases. Clin Transl Oncol. 2017;19:1382–7.CrossRefPubMedGoogle Scholar
  4. 4.
    Patel ND, Broderick DF, Burns J, Deshmukh TK, Fries IB, Harvey HB, et al. ACR appropriateness criteria low back pain. J Am Coll Radiol. 2016;13(9):1069–78.CrossRefPubMedGoogle Scholar
  5. 5.
    Gilbert RW, Kim JH, Posner JB. Epidural spinal cord compression from metastatic tumor: diagnosis and treatment. Ann Neurol. 1978;3:40–51.CrossRefPubMedGoogle Scholar
  6. 6.
    Patel ND, Broderick DF, Burns J, Deshmukh TK, Fries IB, Harvey HB, et al. ACR appropriateness criteria low back pain. J Am Coll Radiol. 2016;13(9):1069–78.CrossRefPubMedGoogle Scholar
  7. 7.
    Deyo RA, Rainville J, Kent DL. What can the history and physical examination tell us about low back pain? JAMA. 1992;268:760–5.CrossRefPubMedGoogle Scholar
  8. 8.
    Verhagen A, Koes B, Downie A, Maher C. Most red flags for malignancy in low back pain guidelines lack empirical support: a systematic review. Pain. 2017;158(10):1860–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Liu Y, Bilsky M, Fourney D, et al. A novel classification system for spinal instability in neoplastic disease an evidence-based approach and expert consensus from the Spine Oncology Study Group. Spine. 2010;35(22):E1221–9.CrossRefGoogle Scholar
  10. 10.
    Colbert SD, Ramakrishna S, Harvey JR, Brennan PA. Metastases in the cervical spine from primary head and neck cancers: current concepts of diagnosis and management. Br J Oral Maxillofac Surg. 2017;55:168–72.CrossRefPubMedGoogle Scholar
  11. 11.
    Chao ST, Koyfman SA, Woody N, Angelov L, Soeder SL, Reddy CA, et al. Recursive partitioning analysis index is predictive for overall survival in patients undergoing spine stereotactic body radiation therapy for spinal metastases. Int J Radiat Oncol Biol Phys. 2012;82:1738–43.CrossRefPubMedGoogle Scholar
  12. 12.
    Gerszten P. Spine metastases: from radiotherapy, surgery, to radiosurgery. Neurosurgery. 2014;61:16–25.CrossRefPubMedGoogle Scholar
  13. 13.
    Patchell R, et al. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet. 2005;366(9486):643–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Bartels RH, van der Linden YM, van der Graaf WT. Spinal extradural metastasis: review of current treatment options. CA Cancer J Clin. 2008;58:245–59.CrossRefPubMedGoogle Scholar
  15. 15.
    Bae JW, Gwak H-S, Kim S, Joo J, Shin SH, Yoo H, et al. Percutaneous vertebroplasty for patients with metastatic compression fractures of the thoracolumbar spine: clinical and radiological factors affecting functional outcomes. Spine J. 2016;16(3):355–64.CrossRefPubMedGoogle Scholar
  16. 16.
    Nas OF, Inecikli MF, Kacar E, Buyukkaya R, Ozkaya G, Aydın O, et al. Effectiveness of percutaneous vertebroplasty in cases of vertebral metastases. Diagn Int Imaging. 2015;96(11):1161–8.CrossRefGoogle Scholar
  17. 17.
    Flagg A, McGreevy K, Williams K. Spinal cord stimulation in the treatment of cancer-related pain: “back to the origins”. Curr Pain Headache Rep. 2012;16:343–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Helweg-Larsen S, Sørensen PS, Kreiner S. Prognostic factors in metastatic spinal cord compression: a prospective study using multivariate analysis of variables influencing survival and gait function in 153 patients. Int J Radiat Oncol*Biol*Phys. 2000;46(5):1163–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Cheville AL, Girardi J, Clark MM, Rummans TA, Pittelkow T, Brown P, et al. Therapeutic exercise during outpatient radiation therapy for advanced cancer: feasibility and impact on physical well-being. Am J Phys Med Rehabil. 2010 Aug 1;89(8):611–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Wong DA, Fornasier VL, MacNab I. Spinal metastases: the obvious, the occult, and the impostors. Spine. 1990;15:1–4.CrossRefPubMedGoogle Scholar
  21. 21.
    Fortin CD, Voth J, Jaglal SB, Craven BC. Inpatient rehabilitation outcomes in patients with malignant spinal cord compression compared to other non-traumatic spinal cord injury: a population based study. J Spinal Cord Med. 2015;38(6):754–64.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Raj VS, Lofton L. Rehabilitation and treatment of spinal cord tumors. J Spinal Cord Med. 2013;36:4–11.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Wallace AN, Greenwood TJ, Jennings JW. Radiofrequency ablation and vertebral augmentation for palliation of painful spinal metastases. J Neurooncology. 2015;124:111–8.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Physical Medicine and Rehabilitation Spine DivisionUniversity of MichiganAnn ArborUSA
  2. 2.Department of Physical Medicine and Rehabilitation Cancer Rehabilitation DivisionUniversity of MichiganAnn ArborUSA

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