Journal of Clinical Orthopaedics | Vol 6 | Issue 2 | Jul-Dec 2021 | page: 16-22 | Siddharth Badve, Arjun Dhawale, Kshitij Chaudhary, Chetan Anchan
Author: Siddharth Badve , Arjun Dhawale , Kshitij Chaudhary , Chetan Anchan 
 Orthopaedic Spine Surgeon, Musculoskeletal Institute, Geisinger Health System; MS (Orthopedics), Lewistown, Pennsylvania, United States of America.
 Orthopaedic Spine Surgeon, Department of Orthopedics, Sir H.N. Reliance Foundation Hospital, Mumbai, Maharashtra, India.
 Orthopaedic Spine Surgeon, Department of Orthopaedics, P.D. Hinduja National Hospital and Research Centre, Mumbai, Maharashtra, India.
 Orthopaedic Onco-surgeon, Department of Orthopaedics, Sir H.N. Reliance Foundation Hospital, Girgaon, Mumbai, Maharashtra, India.
Address of Correspondence
Dr. Siddharth Badve,
Orthopaedic Spine Surgeon, Musculoskeletal Institute, Geisinger Health System; MS (Orthopedics), Lewistown, Pennsylvania, United States of America
Spinal metastasis is a frequent occurrence in patients presenting with advanced malignancy. The burden of this condition is on rise, especially with the availability of aggressive treatment regimens for the primary disease and the improvement in the patient survival. Thoracic spine is the most affected region. The likely source of the primary is from the breast, prostate, lung, thyroid, or kidney. Certain hematological and other malignant conditions can also develop an early spinal involvement that requires timely evaluation and management. The goals for the management of the spinal lesion include preservation of the neurological function, pain control, and maintenance of spinal stability. On the whole, the aim of the treatment continues to palliation in majority of the scenarios. The management strategy is based on the factors that include the patient condition, life expectancy, nature of the tumor pathology, extent of spinal cord compression, severity of neurological deficit, pain control, and the effect on spinal stability. A multidisciplinary approach involving medical oncology, radiation oncology, spine surgery, palliative care and other subspecialtiess forms the cornerstone of the management. Although giant strides have been reported in the advancement of the treatment for spinal metastasis, majority of these avenues are beyond the reach of the patient population from the developing societies. Lack of referral facilities, resource constraints, and geographic disparities are major impediments. The lack of awareness and consensus on the management protocols within the treatment team and the medical community in general poses another challenge in providing an acceptable standard of care. This article offers an insight into the principles that guide the management of spinal metastasis. The application of these principles in the background of the resource constraints that are unique to the South Asian population has also been addressed. This is a synopsis on the multidisciplinary approach to the diagnosis and management of spinal metastasis along with the review of the relevant literature.
Keywords: Vertebral metastasis, spinal stability, pathological fracture, spinal cord compression
1. Rose PS, Buchowski JM. Metastatic disease in the thoracic and lumbar spine: Evaluation and management. J Am Acad Orthop Surg 2011;19:37-48.
2. White AP, Kwon BK, Lindskog DM, Friedlaender GE, Grauer JN. Metastatic disease of the spine. J Am Acad Orthop Surg 2006;14:587-98.
3. Kirchhoff SB, Becker C, Duerr HR, Reiser M, Baur-Melnyk A. Detection of osseous metastases of the spine: Comparison of high resolution multi-detector-CT with MRI. Eur J Radiol 2009;69:567-73.
4. Edelstyn GA, Gillespie PJ, Grebbell FS. The radiological demonstration of osseous metastasis: Experimental observations. Clin Radiol 1967;18:158-62.
5. Tatsui H, Onomura T, Morishita S, Oketa M, InoueT. Survival rates of patients with metastatic spinal cancer after scintigraphic detection of abnormal radioactive accumulation. Spine (Phila Pa 1976) 1996;21:2143-8.
6. Rougraff BT, Kneisl JS, Simon MA. Skeletal metastases of unknown origin: A prospective study of a diagnostic strategy. J Bone Joint Surg Am 1993;75:1276-81.
7. Bredella MA, Essary B, Torriani M, Ouellette HA, Palmer WE. Use of FDG-PET in differentiating benign from malignant compression fractures. Skeletal Radiol 2008;37:405-13.
8. Metser U, Lerman H, Blank A, Lievshitz G, Bokstein F, EvenSapir E. Malignant involvement of the spine: Assessment by 18F-FDG PET/CT. J Nucl Med 2004;45:279-84.
9. Lis E, Bilsky MH, Pisinski L, Boland P, Healey JH, O’malley B, et al. Percutaneous CT-guided biopsy of osseous lesion of the spine in patients with known or suspected malignancy. AJNR Am J Neuroradiol 2004;25:1583-8.
10. Patchell RA, Tibbs PA, Regine WF, Payne R, Saris S, Kryscio RJ, et al. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: Arandomised trial. Lancet 2005;366:643-8.
11. Cole JS, Patchell RA. Metastatic epidural spinal cord compression. Lancet Neurol 2008;7:459-66.
12. Sharan AD, Szulc A, Krystal J, Yassari R, Laufer I, Bilsky MH. The integration of radiosurgery for the treatment of patients with metastatic spine diseases. J Am Acad Orthop Surg 2014;22:447-54.
13. Maranzano E, Bellavita R, Rossi R, de Angelis V, Frattegiani A, Bagnoli R, et al. Short-course versus split-course radiotherapy in metastatic spinal cord compression: Results of a Phase III, randomized, multicenter trial. J Clin Oncol 2005;23:3358-65.
14. Tokuhashi Y, Matsuzaki H, Oda H, Oshima M, Ryu J. A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis. Spine (Phila Pa 1976) 2005;30:2186-91.
15. Tokuhashi Y, Uei H, Oshima M, Ajiro Y. Scoring system for prediction of metastatic spine tumor prognosis. World J Orthop 2014;5:262-71.
16. Fisher CG, DiPaola CP, Ryken TC, Bilsky MH, Shaffrey CI, Berven SH, et al. A novel classification system for spinal instability in neo-plastic disease: An evidence-based approach and expert consensus from the spine oncology study group. Spine (Phila Pa 1976) 2010;35:E1221-9.
17. Laufer I, Rubin DG, Lis E, Cox BW, Stubblefield MD, Yamada Y, et al. The NOMS framework: Approach to the treatment of spinal metastatic tumors. Oncologist 2013;18:744-51.
18. Health Quality Ontario. Vertebral augmentation involving vertebroplasty or kyphoplasty for cancer-related vertebral compression fractures: A systematic review. Ont Health Technol Assess Ser 2016;16:1-202.
|How to Cite this article: Badve S, Dhawale A, Chaudhary K, Anchan C. A multidisciplinary approach to the management of spinal metastasis: A review article. Journal of Clinical Orthopaedics Jul-Dec 2021;6(2):16-22.|