Skip to main content

Advertisement

Log in

Principles of Management of Spine Metastasis

  • Review Article
  • Published:
Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

Background

With evolution of medicine, radiation therapy and surgical methods, cancer care has improved the quality of life for patients with improved survival and functional status in patients with skeletal metastasis. The most common site of skeletal metastases from other primary malignant neoplasms is the spine, hence, understanding the epidemiology of metastatic spine disease and its presentation is essential for developing a diagnostic and treatment strategy which eventually results in optimum care to reduce disease-related morbidity.

Purpose

With this review article we intend to describe an evidence-based review on the presentation, diagnosis and treatment of metastatic spinal disease.

Methods

We reviewed the current available literature on management of spinal metastasis and have described a step wise evaluation and management strategy of metastatic spine disease.

Conclusion

The present review article addresses various aspects and related controversies related to evaluation, staging and treatment options in the management of spinal metastasis.

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

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Hosono, N., Yonenobu, K., Fuji, T., Ebara, S., Yamashita, K., & Ono, K. (1995). Orthopaedic management of spinal metastases. Clinical Orthopaedics and Related Research,312, 148–159.

    Google Scholar 

  2. Greenlee, R. T., Murray, T., Bolden, S., & Wingo, P. A. (2000). Cancer statistics, 2000. CA: A Cancer Journal for Clinicians,50(1), 7–33. https://doi.org/10.3322/canjclin.50.1.7.

    Article  CAS  Google Scholar 

  3. Gerzten, P. C., & Welsch, W. C. (2000). Current surgical managment of metastatic spinal disease. Oncology (Huntingt),14, 1013–1014. [Discussion 1024, 1029–1030].

    Google Scholar 

  4. Joaquim, A. F., Ghizoni, E., Tedeschi, H., Pereira, E. B., & Giacomini, L. A. (2013). Stereotactic radiosurgery for spinal metastases: A literature review. Einstein (São Paulo),11(2), 247–255. https://doi.org/10.1590/s1679-45082013000200020.

    Article  Google Scholar 

  5. Rosenthal, D. I. (1997). Radiologic diagnosis of bone metastases. Cancer,80(8), 1595–1607.

    Article  CAS  Google Scholar 

  6. Yimin, Y., Zhiwei, R., Wei, M., & Jha, R. (2013). Current status of percutaneous vertebroplasty and percutaneous kyphoplasty--a review. Medical Science Monitor,19, 826–836. https://doi.org/10.12659/MSM.889479

    Article  PubMed  PubMed Central  Google Scholar 

  7. Buhmann (Kirchoff), S., Becker, C., Duerr, H. R., Reiser, M., & Baur-Melnyk, A. (2009). Detection of osseous metastases of the spine: Comparison of high resolution multi-detector-CT with MRI. European Journal of Radiology,69(3), 567–573. https://doi.org/10.1016/j.ejrad.2007.11.03.

    Article  Google Scholar 

  8. Avrahami, E., Tadmor, R., Daily, O., Hadar, H. (1989). Early MR demonstration of spinal metastases in patients with normal radiographs and CT and radionuclide bone scans. Journal of Computer Assisted Tomography, 13(4), 598–602

    Article  CAS  Google Scholar 

  9. Hamaoka, T., Madewell, J. E., Podoloff, D. A., Hortobagyi, G. N., & Ueno, N. T. (2004). Bone imaging in metastatic breast cancer. Journal of Clinical Oncology,22, 2942–2953.

    Article  Google Scholar 

  10. Mendel, E., Bourekas, E., Gerszten, P., & Golan, J. D. (2009). Percutaneous techniques in the treatment of spine tumors: What are the diagnostic and therapeutic indications and outcomes? Spine,34(22 Suppl), S93–S100. https://doi.org/10.1097/brs.0b013e3181b77895.

    Article  PubMed  Google Scholar 

  11. Kumar, A., Weber, M. H., Gokaslan, Z., Wolinsky, J. P., Schmidt, M., Rhines, L., et al. (2017). Metastatic spinal cord compression and steroid treatment. Clinical Spine Surgery,30(4), 156–163.

    Article  Google Scholar 

  12. Perrin, R. G., & Laxton, A. W. (2004). Metastatic spine disease: Epidemiology, pathophysiology, evaluation of patients. Neurosurgery Clinics of North America,15(4), 365–373.

    Article  Google Scholar 

  13. Kato, S., Hozumi, T., Yamakawa, K., Higashikawa, A., Goto, T., Kondo, T., et al. (2013). Hormonal therapy with external radiation therapy for metastatic spinal cord compression from newly diagnosed prostate cancer. Journal of Orthopaedic Science,18(5), 819–825.

    Article  CAS  Google Scholar 

  14. Bucholtz, J. D. (1999). Metastatic epidural spinal cord compression. Seminars in Oncology Nursing,15(3), 150–159. https://doi.org/10.1016/s0749-2081(99)80002-3.

    Article  CAS  PubMed  Google Scholar 

  15. Maranzano, E., Latini, P., Beneventi, S., et al. (1996). Radiotherapy without steroids in selected metastatic spinal cord compression patients. American Journal of Clinical Oncology,19, 179–183.

    Article  CAS  Google Scholar 

  16. Hortobagyi, G. N., Theriault, R. L., Lipton, A., et al. (1998). Long-term prevention of skeletal complications of metastatic breast cancer with pamidronate. Protocal 19 aredia breast cancer study group. Journal of Clinical Oncology,16, 2038–2044.

    Article  CAS  Google Scholar 

  17. Berenson, J. R., Lichtenstein, A., Porter, L., et al. (1996). Efficacy of pamidronate in reducing skeletal events in patients with advanced multiple myeloma. New England Journal of Medicine,334, 488–493.

    Article  CAS  Google Scholar 

  18. Coukell, A. J., & Markham, A. (1998). Pamidronate. A review of its use in the management of osteolytic bone metastases, tumour-induced hypercalcaemia and Paget’s disease of the bone. Drugs and Aging,12, 149–168.

    Article  CAS  Google Scholar 

  19. Laufer, I., Iorgulescu, J. B., Chapman, T., Lis, E., Shi, W., Zhang, Z., 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. Journal of Neurosurgery: Spine,18(3), 207–214. https://doi.org/10.3171/2012.11.spine12111.

    Article  PubMed  Google Scholar 

  20. Findlay, G. F. G. (1984). Adverse effects of the management of malignant spinal cord compression. Journal of Neurology, Neurosurgery and Psychiatry,47, 761–768.

    Article  CAS  Google Scholar 

  21. Gilbert, R. W., Kim, J. H., & Posner, J. B. (1978). Epidural spinal cord compression, metastatic tumour: Diagnosis and treatment. Annals of Neurology,3, 40–51.

    Article  CAS  Google Scholar 

  22. Gerszten, P. C., Burton, S. A., Ozhasoglu, C., & Welch, W. C. (2007). Radiosurgery for spinal metastases: Clinical experience in 500 cases from a single institution. Spine,32(2), 193–199. https://doi.org/10.1097/01.brs.0000251863.76595.a2.

    Article  PubMed  Google Scholar 

  23. Guckenberger, M., Mantel, F., Gerszten, P. C., Flickinger, J. C., Sahgal, A., Létourneau, D., et al. (2014). Safety and efficacy of stereotactic body radiotherapy as primary treatment for vertebral metastases: A multi-institutional analysis. Radiation Oncology,9(1), 226. https://doi.org/10.1186/s13014-014-0226-2.

    Article  PubMed  Google Scholar 

  24. Patchell, R. A., Tibbs, P. A., Regine, W. F., Payne, R., Saris, S., Kryscio, R. J., 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.

    Article  Google Scholar 

  25. Tomita, K., Kawahara, K., Kobayashi, T., et al. (2001). Surgical strategy for spinal metastases. Spine,26, 298–306.

    Article  CAS  Google Scholar 

  26. Hosono, N., Yonenobu, K., Fuji, T., et al. (1995). Vertebral body replacement with ceramic prosthesis for metastatic spinal tumors. Spine,20, 2454–2462.

    Article  CAS  Google Scholar 

  27. Kostuik, J. P. (1983). Anterior spinal cord decompression for lesions of the thoracic and lumbar spine, techniques, new methods of internal fixation results. Spine,8, 512–531.

    Article  CAS  Google Scholar 

  28. Perrin, R. G., & McBroom, R. J. (1987). Anterior versus posterior decompression for symptomatic spinal metastasis. Canadian Journal of Neurological Sciences,14, 75–80.

    Article  CAS  Google Scholar 

  29. Klekamp, J., & Samii, H. (1998). Surgical results for spinal metastases. Acta Neurochirurgica (Wien),140, 957–967.

    Article  CAS  Google Scholar 

  30. Maranzano, E., et al. (2009). 8 Gy single-dose radiotherapy is effective in metastatic spinal cord compression: Results of a phase III randomized multicentre Italian trial. Radiotherapy and Oncology,93(2), 174–179. https://doi.org/10.1016/j.radonc.2009.05.012. [Epub 2009 Jun 10].

    Article  PubMed  Google Scholar 

  31. Arrigo, R. T., Kalanithi, P., Cheng, I., Alamin, T., Carragee, E. J., Mindea, S. A., et al. (2011). Predictors of survival after surgical treatment of spinal metastasis. Neurosurgery,68(3), 674–681.

    Article  Google Scholar 

  32. Salapura, V., & Jeromel, M. (2014). Minimally invasive (percutaneous) treatment of metastatic spinal and extraspinal disease—A review. Acta Clinica Croatica,53(1), 44–54.

    PubMed  Google Scholar 

  33. Burton, A. W., & Mendel, E. (2003). Vertebroplasty and kyphoplasty. Pain Physician,6(3), 335–341.

    PubMed  Google Scholar 

  34. Bartolozzi, B., Nozzoli, C., Pandolfo, C., Antonioli, E., Guizzardi, G., Morichi, R., et al. (2006). Percutaneous vertebroplasty and kyphoplasty in patients with multiple myeloma. European Journal of Haematology,76(2), 180–181.

    Article  Google Scholar 

  35. Palussiere, J., Pellerin-Guignard, A., Descat, E., Cornelis, F., & Dixmerias, F. (2012). Radiofrequency ablation of bone tumours. Diagnostic and Interventional Imaging,93(9), 660–664.

    Article  CAS  Google Scholar 

  36. Yang, Z., et al. (2015). Minimal access versus open spinal surgery in treating painful spine metastasis: A systematic review. World Journal of Surgical Oncology,13, 68. https://doi.org/10.1186/s12957-015-0468.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Laufer, I., Rubin, D. G., Lis, E., Cox, B. W., Stubblefield, M. D., Yamada, Y., et al. (2013). The NOMS framework: Approach to the treatment of spinal metastatic tumors. Oncologist,18(6), 744–751. https://doi.org/10.1634/theoncologist.2012-0293.

    Article  PubMed  PubMed Central  Google Scholar 

  38. International standards for neurological and functional classifications of spinal cord injury. American Spinal Injury Association, Chicago, IL, 1982 (Revised 1996)

  39. Tokuhashi, Y., Matsuzaki, H., Oda, H., Oshima, M., & Ryu, J. (2005). A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis. Spine,30(19), 2186–2191. https://doi.org/10.1097/01.brs.0000180401.06919.a5.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ashish Gulia.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard statement

This is a review article. The article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all the patients whose imaging has been published.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kurisunkal, V., Gulia, A. & Gupta, S. Principles of Management of Spine Metastasis. JOIO 54, 181–193 (2020). https://doi.org/10.1007/s43465-019-00008-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s43465-019-00008-2

Keywords

Navigation