Advertisement

Metastatic Disease of the Lumbar Spine

  • Scott E. Dart
  • Patrick Moody
  • Joshua C. Patt
Chapter

Abstract

The number of cases of lumbar spine metastatic disease will continue to increase with the improvement of cancer care in the United States. Accordingly, multidisciplinary groups including spine surgeons are required to provide care with the goal of improving each patient’s quality of life. With its unique anatomy, the lumbar spine requires a different approach to treatment compared to other areas of the spine. These treatments range from nonoperative to operative treatments and can be utilized with the application of validated treatment algorithms. Nonoperative treatment includes the modalities of corticosteroids and chemotherapy but often employs the use of radiotherapy. Operative treatment can address neural compression, instability, and pain among other needs. This chapter seeks to address the epidemiology of lumbar metastatic disease, review the anatomy of the lumbar spine, cover the workup including imaging utilized, and discuss treatment strategy including both nonoperative and operative treatment of metastatic lumbar disease.

Keywords

Lumbar metastatic disease Indications for surgery Cauda equina Epidural compression Spinal instability 

References

  1. 1.
    Luksanapruksa P, et al. Perioperative complications of spinal metastases surgery. Clin Spine Surg. 2017;30(1):4–13.CrossRefPubMedGoogle Scholar
  2. 2.
    American Cancer Society. Cancer Facts and Figures 2017. Atlanta: American Cancer Society; 2017.Google Scholar
  3. 3.
    Miller KD, et al. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin. 2016;66(4):271–89.CrossRefPubMedGoogle Scholar
  4. 4.
    Disibio G, French SW. Metastatic patterns of cancers: results from a large autopsy study. Arch Pathol Lab Med. 2008;132(6):931–9.PubMedGoogle Scholar
  5. 5.
    Guillevin R, et al. Spine metastasis imaging: review of the literature. J Neuroradiol. 2007;34(5):311–21.CrossRefPubMedGoogle Scholar
  6. 6.
    Schulman KL, Kohles J. Economic burden of metastatic bone disease in the U.S. Cancer. 2007;109(11):2334–42.CrossRefPubMedGoogle Scholar
  7. 7.
    Rose PS, Buchowski JM. Metastatic disease in the thoracic and lumbar spine: evaluation and management. J Am Acad Orthop Surg. 2011;19(1):37–48.CrossRefPubMedGoogle Scholar
  8. 8.
    Brihaye J, et al. The management of spinal epidural metastases. Adv Tech Stand Neurosurg. 1988;16:121–76.CrossRefPubMedGoogle Scholar
  9. 9.
    Harrington K. Metastatic disease of the spine. In: Orthopaedic management of metastatic bone disease. St. Louis: Moshy Co.; 1988.Google Scholar
  10. 10.
    Bos GD, Edersold M, McLeod RA. Lesions of the spine. In: Sim FH, editor. Diagnosis and treatment of metastatic bone disease. New York: Raven Press; 1988.Google Scholar
  11. 11.
    Boland PJ, Lane JM, Sundaresan N. Metastatic disease of the spine. Clin Orthop Relat Res. 1982;169:95–102.Google Scholar
  12. 12.
    Arguello F, et al. Pathogenesis of vertebral metastasis and epidural spinal cord compression. Cancer. 1990;65(1):98–106.CrossRefGoogle Scholar
  13. 13.
    Batson OV. The function of the vertebral veins and their role in the spread of metastases. Ann Surg. 1940;112(1):138–49.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Jacobs WB, Perrin RG. Evaluation and treatment of spinal metastases: an overview. Neurosurg Focus. 2001;11(6):e10.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Bhatt AD, et al. Current and emerging concepts in non-invasive and minimally invasive management of spine metastasis. Cancer Treat Rev. 2013;39(2):142–52.CrossRefPubMedGoogle Scholar
  16. 16.
    Weinstein PR. The application of anatomy and pathophysiology in the management of lumbar spine disease. Clin Neurosurg. 1980;27:517–40.CrossRefPubMedGoogle Scholar
  17. 17.
    Crock HV. Normal and pathological anatomy of the lumbar spinal nerve root canals. J Bone Joint Surg Br. 1981;63B(4):487–90.CrossRefPubMedGoogle Scholar
  18. 18.
    Schneck CD. The anatomy of lumbar spondylosis. Clin Orthop Relat Res. 1985;193:20–37.Google Scholar
  19. 19.
    Ebraheim NA, et al. Anatomic considerations of the lumbar isthmus. Spine (Phila Pa 1976). 1997;22(9):941–5.CrossRefGoogle Scholar
  20. 20.
    Andersson GB. Epidemiological features of chronic low-back pain. Lancet. 1999;354(9178):581–5.CrossRefGoogle Scholar
  21. 21.
    Gilbert RW, Kim JH, Posner JB. Epidural spinal cord compression from metastatic tumor: diagnosis and treatment. Ann Neurol. 1978;3(1):40–51.CrossRefPubMedGoogle Scholar
  22. 22.
    Patel ND, et al. ACR appropriateness criteria low back pain. J Am Coll Radiol. 2016;13(9):1069–78.CrossRefPubMedGoogle Scholar
  23. 23.
    White AP, et al. Metastatic disease of the spine. J Am Acad Orthop Surg. 2006;14(11):587–98.CrossRefPubMedGoogle Scholar
  24. 24.
    Korse NS, et al. Cauda Equina syndrome: presentation, outcome, and predictors with focus on micturition, defecation, and sexual dysfunction. Eur Spine J. 2017;26(3):894–904.CrossRefPubMedGoogle Scholar
  25. 25.
    Kotil K, Kilinc BM, Bilge T. Spinal metastasis of occult lung carcinoma causing cauda equina syndrome. J Clin Neurosci. 2007;14(4):372–5.CrossRefPubMedGoogle Scholar
  26. 26.
    Fisher CG, et al. A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group. Spine (Phila Pa 1976). 2010;35(22):E1221–9.CrossRefGoogle Scholar
  27. 27.
    Henschke N, et al. Red flags to screen for malignancy in patients with low-back pain. Cochrane Database Syst Rev. 2013;(2):CD008686.Google Scholar
  28. 28.
    Buhmann Kirchhoff S, et al. Detection of osseous metastases of the spine: comparison of high resolution multi-detector-CT with MRI. Eur J Radiol. 2009;69(3):567–73.CrossRefPubMedGoogle Scholar
  29. 29.
    Maranzano E, Latini P. Effectiveness of radiation therapy without surgery in metastatic spinal cord compression: final results from a prospective trial. Int J Radiat Oncol Biol Phys. 1995;32(4):959–67.CrossRefPubMedGoogle Scholar
  30. 30.
    Edelstyn GA, Gillespie PJ, Grebbell FS. The radiological demonstration of osseous metastases. Experimental observations. Clin Radiol. 1967;18(2):158–62.CrossRefPubMedGoogle Scholar
  31. 31.
    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(9):1276–81.CrossRefPubMedGoogle Scholar
  32. 32.
    Phelps KP, Patt JC. Diagnosis and management of patients with carcinoma metastatic to the spine. Curr Orthop Pract. 2014;25(6):525–33.CrossRefGoogle Scholar
  33. 33.
    Tomita K. Surgery strategy for spinal metastases. Spine (Phila Pa 1976). 2001;26(3):298–306.CrossRefGoogle Scholar
  34. 34.
    Tokuhashi Y, et al. A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis. Spine (Phila Pa 1976). 2005;30(19):2186–91.CrossRefGoogle Scholar
  35. 35.
    Laufer I, et al. The NOMS framework: approach to the treatment of spinal metastatic tumors. Oncologist. 2013;18:744–51.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Fourney DR, et al. Spinal instability neoplastic score: an analysis of reliability and validity from the spine oncology study group. J Clin Oncol. 2011;29(22):3072–7.CrossRefPubMedGoogle Scholar
  37. 37.
    Walker MP, et al. Metastatic disease of the spine: evaluation and treatment. Clin Orthop Relat Res. 2003;(415 Suppl):S165–75.CrossRefGoogle Scholar
  38. 38.
    National Comprehensive Cancer Network: NCCN Guidelines—Metastatic Spine Tumors. https://www.nccn.org/professionals/physician_gls/pdf/cns.pdf. Retrieved April 30, 2017.
  39. 39.
    Cole JS, Patchell RA. Metastatic epidural spinal cord compression. Lancet Neurol. 2008;7(5):459–66.CrossRefPubMedGoogle Scholar
  40. 40.
    Sciubba DM, et al. Diagnosis and management of metastatic spinal disease. J Neurosurg Spine. 2010;13:94–108.CrossRefPubMedGoogle Scholar
  41. 41.
    Gerszten PC, Mendel E, Yamada Y. Radiotherapy and radiosurgery for metastatic spine disease: what are the options, indications, and outcomes? Spine (Phila Pa 1976). 2009;34(22 Suppl):S78–92.CrossRefGoogle Scholar
  42. 42.
    Boyce-Fappiano D, et al. Analysis of the factors contributing to vertebral compression fractures after spine stereotactic radiosurgery. Int J Radiat Oncol Biol Phys. 2017;97(2):236–45.CrossRefPubMedGoogle Scholar
  43. 43.
    Quraishi NA, et al. Effect of timing of surgery on neurological outcome and survival in metastatic spinal cord compression. Eur Spine J. 2013;22:1383–8.CrossRefPubMedGoogle Scholar
  44. 44.
    Yalamanchili M, Lesser GJ. Malignant spinal cord compression. Curr Treat Options in Oncol. 2003;4:509–16.CrossRefGoogle Scholar
  45. 45.
    Patchell RA, et al. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet. 2005;366(9486):643–8.CrossRefPubMedGoogle Scholar
  46. 46.
    Young RF, Post EM, King GA. Treatment of spinal epidural metastases. Randomized prospective comparison of laminectomy and radiotherapy. J Neurosurg. 1980;53:741–8.CrossRefPubMedGoogle Scholar
  47. 47.
    Kostuik JP, et al. Spinal stabilization of vertebral column tumors. Spine (Phila Pa 1976). 1988;13(3):250–6.CrossRefGoogle Scholar
  48. 48.
    Harrington KD. Anterior decompression and stabilization of the spine as a treatment for vertebral collapse and spinal cord compression from metastatic malignancy. Clin Orthop Relat Res. 1988;233:177–97.Google Scholar
  49. 49.
    Bilsky MH, et al. Single-stage posterolateral transpedicle approach for spondylectomy, epidural decompression, and circumferential fusion of spinal metastases. Spine (Phila Pa 1976). 2000;25(17):2240–9.CrossRefGoogle Scholar
  50. 50.
    Zairi F, et al. Minimally invasive decompression and stabilization for the management of thoracolumbar spine metastasis. J Neurosurg Spine. 2012;17:19–23.CrossRefPubMedGoogle Scholar
  51. 51.
    Taneichi H, et al. Risk factors and probability of vertebral body collapse in metastases of the thoracic and lumbar spine. Spine (Phila Pa 1976). 1997;22(3):239–45.CrossRefGoogle Scholar
  52. 52.
    Lee Y, Kuper M. Percutaneous pedicle screw fixation in the lumbar spine. In: Wang JC, editor. Advanced reconstruction: spine. Rosemont: AAOS; 2011. p. 471–6.Google Scholar
  53. 53.
    Chang T, et al. Low profile pelvic fixation: anatomic parameters for sacral alar-iliac fixation versus traditional iliac fixation. Spine (Phila Pa 1976). 2009;34(5):436–40.CrossRefGoogle Scholar
  54. 54.
    Yao KC, et al. En bloc spondylectomy for spinal metastases: a review of techniques. Neurosurg Focus. 2003;15(5):1–6.CrossRefGoogle Scholar
  55. 55.
    Allen RT, Phillips FM. Kyphoplasty and vertebroplasty. In: Wang JC, editor. Advanced reconstruction: spine. Rosemont: AAOS; 2011. p. 651–60.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Scott E. Dart
    • 1
  • Patrick Moody
    • 2
  • Joshua C. Patt
    • 1
    • 2
  1. 1.Department of Orthopaedic SurgeryCarolinas Medical Center, Atrium HealthCharlotteUSA
  2. 2.Levine Cancer Institute, Atrium HealthCharlotteUSA

Personalised recommendations