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Management der Wirbelsäulenmetastasen, Strategien und operative Indikationen

Management of spinal metastases, strategies and surgical indications

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Zusammenfassung

Metastasen sind die häufigste maligne Läsion der Wirbelsäule unabhängig vom Primarius und Indikator für ein disseminiertes Tumorleiden. Aufgrund der Optimierung der spezifischen onkologischen Therapiestrategien in den letzten Dekaden und der damit assoziierten steigenden Lebenserwartung stellen Wirbelsäulemetastasen ein wachsendes Problem dar. Deshalb muss gerade bei diesen Patienten eine onkologisch optimale, sinnvolle und patientengerechte Wahl des Therapieverfahrens unter Einbeziehung der Tumorbiologie, Prognose der Überlebenszeit, Vorliegen neurologischer Defizite, Instabilität und Allgemeinzustand des Patienten erfolgen. Die Therapie muss die Lebensqualität des Patienten berücksichtigen. Die Therapieoptionen reichen von einer rein konservativen Behandlung bis zu einer En-bloc-Spondylektomie der metastatischen Läsion. Basierend auf prognostischen Scores muss die chirurgische Entscheidungsfindung unter Berücksichtigung der Differenzialindikationen zu verschiedenen chirurgischen Therapieverfahren individuell entschieden werden.

Abstract

The number of bone metastases increases with prolonged survival of primary tumors of kidney, breast, prostate and other tumors. The spine is the most frequent site of bone metastases. This leads to high number of patients where the decision has to be made what kind of treatment should be the best. Several scores have been developed to solve this problem. The decision has to include the biology of the metastatic disease according to primary tumor and dissemination of the disease, the general condition of the patient, the residual stability of the spine, the neurologic status and most important the quality of life of the patient. Treatment options range from conservative treatment up to en bloc resection of the metastatic lesion. Therefore, the strategy of treatment always has to be decided on an individual base.

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Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht.

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Correspondence to Dr. B. Lehner.

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Akbar, M., Ayache, A., Eichler, M. et al. Management der Wirbelsäulenmetastasen, Strategien und operative Indikationen. Orthopäde 41, 632–639 (2012). https://doi.org/10.1007/s00132-012-1910-2

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Schlüsselwörter

  • Wirbelsäulenmetastasen
  • Behandlungsalgorithmus
  • Behandlungsstrategie
  • Differentialindikationen
  • Operative Therapie

Keywords

  • Spinal metastases
  • Treatment algorithm
  • Treatment strategy
  • Differential indications
  • Surgical treatment