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Chirurgisches Management von Wirbelsäulenmetastasen

Surgical management of vertebral column metastatic disease

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Zusammenfassung

Die Wirbelsäule ist die Hauptlokalisation von Skelettmetastasen. Diese sind die häufigsten malignen Läsionen der Wirbelsäule und Anzeichen eines disseminierten Tumorleidens. In Abhängigkeit von primärer Tumorbiologie, Prognose der Überlebenszeit, Vorliegen sensomotorischer Defizite, spinaler Instabilität und Gesamtzustand des Patienten muss eine onkologisch sinnvolle und patientengerechte Wahl des therapeutischen Verfahrens erfolgen. Die Etablierung ventraler und erweiterter dorsaler Zugänge und Resektionen sowie neuer Stabilisierungstechniken hat die Grenze zugunsten eines Wandels von konservativen Methoden zur primär chirurgischen Intervention verschoben. Verschiedene valide, prognostische Scores können als Basis für die Differenzialindikation zu verschiedenen chirurgischen Therapieverfahren herangezogen werden und eine individuelle Entscheidungsfindung erleichtern. Indikationen für chirurgisches Vorgehen bestehen bei einer Überlebensprognose von mindestens 3 Monaten, unbeherrschbaren Schmerzen, Progress spinaler Kompression, neurologischer Befundverschlechterung unter Radiochemotherapie, spinaler Instabilität und notwendiger histologischer Befundsicherung.

Abstract

The spine is the most frequent site of skeletal metastases. Among all spinal malignancies metastatic disease is most frequent and indicative of disseminating tumor disease. Depending on primary tumor entity, estimated survival time, general health status of the patient, presence of spinal instability and neurological deficits an oncological useful and patient-specific therapeutic intervention should be performed. New anterior approaches, resections and reconstruction techniques are making surgery a preferred method over radiation therapy. For differential indication of the multiple surgical treatment modalities prognostic scores are available to assist individual decision making. Indications for surgery include survival prognosis of minimum 3 months, intractable pain, progress of myelon compression and/or neurological deficits under radiochemotherapy, spinal instability and necessity for histological diagnosis. Resulting quality of life depends on efficient decompression of the spinal cord and restoration of spinal stability. To achieve these ultimate goals there are different anterior and posterior approaches, instrumentations and vertebral body replacement implants available. Preoperative embolization should be performed in hypervascular tumors, e.g., renal cell cancer. Vertebro-/Kyphoplasty as a percutaneous intervention should be considered for painful multisegmental disease and symptomatic osteolysis without epidural tumor compression to reach analgesia and stability. A multidisciplinary approach in patient selection, decision making and management is an essential precondition for complication avoidance and acceptable quality of life.

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  1. Centrum für Muskuloskeletale Chirurgie,Sektion Muskuloskeletale Tumorchirurgie, Charité – Universitätsmedizin Berlin, Klinik für Unfall- & Wiederherstellungschirurgie,Klinik für Orthopädie, Augustenburger Platz 1, 13353, Berlin, Deutschland

    K.-D. Schaser, I. Melcher, A. Schulz, N.P. Haas & A.C. Disch

  2. Abteilung für Unfall- und Wiederherstellungschirurgie, Chirurgische Klinik und Poliklinik der Universität Rostock, Rostock, Deutschland

    T. Mittlmeier

  3. Klinik für Strahlenheilkunde, Abteilung für Neuroradiologie, Charité – Universitätsmedizin Berlin, Berlin, Deutschland

    J.H. Seemann

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Schaser, KD., Melcher, I., Mittlmeier, T. et al. Chirurgisches Management von Wirbelsäulenmetastasen. Unfallchirurg 110, 137–162 (2007). https://doi.org/10.1007/s00113-007-1232-8

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  • DOI: https://doi.org/10.1007/s00113-007-1232-8

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