Surgical Management of Bone Metastasis

Abstract

The surgical treatment of bone metastases aims to reduce pain, improve function, prevent tumour progression and decrease complications. Surgery is indicated only for patients with an expected survival of 3–6 months. In other cases, palliative treatment is preferred.

Wide or marginal excision is always associated with osteosynthesis or prosthetic reconstruction. Long-bone metastasis osteosynthesis aims to guarantee an early full weight-bearing allowing daily activities. Plating could be adapted only for upper limb lesions and other segments that do not require weight-bearing or in situations when intramedullary nailing is complex to be used. Intramedullary nailing is the preferred fixation devices for diaphyseal metastasis, due to the ease of insertion, reduced invasiveness, short operatory timing, reduced bleeding, low costs and mechanical properties.

The most frequent site for solid tumour metastases is the spine. In fact, 5–10% of patients with systemic cancer develop spinal metastases during their life. Surgical management is required in case of neurological symptoms or nonresponsive therapy. In selected patients, with good long-term prognosis and single metastasis, a complete excision of the tumoural mass could be performed. In other cases, the “debulking” of the mass with indirect decompression, followed by stabilization, is indicated. This surgery aims to decompress the spinal canal, reduce pain and improve the quality of life.