Abstract
The management of the patient affected by spinal metastases requires an integrated multidisciplinary approach. Surgery and radiotherapy being the mainstay of the treatment of these fragile patients, clinical and surgical trials are required to determine which patients will benefit most from these treatments when affected by metastatic epidural spinal cord compression. In recent years, a newer and more important role for radiotherapy is emerging for these patients; in particular, stereotactic radiosurgery is used as an adjuvant to the decompressive surgery for management of these patients.
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References
Tubiana-Hulin M. Incidence, prevalence and distribution of bone metastases. Bone. 1991;12(Suppl 1):S9–10.
Durr HR, Maier M, Pfahler M, Baur A, Refior HJ. Surgical treatment of osseous metastases in patients with renal cell carcinoma. Clin Orthop Relat Res. 1999;367:283–90.
Sundaresan N, Digiacinto GV, Hughes JE. Surgical treatment of spinal metastases. Clin Neurosurg. 1986;33:503–22.
Fornasier VL, Horne JG. Metastases to the vertebral column. Cancer. 1975;36:590–4.
Schuster JM, Grady MS. Medical management and adjuvant therapies in spinal metastatic disease. Neurosurg Focus. 2001;11(6):e3.
Raque GH Jr, Vitaz TW, Shields CB. Treatment of neoplastic diseases of the sacrum. J Surg Oncol. 2001;76:301–7.
Gasbarrini A, Boriani S, Capanna R, Casadei R, Di Martino A, Spinelli MS, Papapietro N, Piccioli A, The Italian Orthopaedic Society Bone Metastasis Study Group. Management of patients with metastasis to the vertebrae: recommendations from the Italian Orthopaedic Society (SIOT) Bone Metastasis Study Group. Expert Rev Anticancer Ther. 2014;14:143–50.
Coleman RE. Clinical features of metastatic bone disease and risk of skeletal morbidity. Clin Cancer Res. 2006;12(20 Pt 2):6243s–9s.
Coleman RE. Skeletal complications of malignancy. Cancer. 1997;80(8 Suppl):1588–94.
Vrionis FD, Miguel R. Management of spinal metastases. Semin Pain Med. 2003;11:25–33.
Dewald RL, Bridwell KH, Prodromas C, Rodts MF. Reconstructive spinal surgery as palliation for metastatic malignancies of the spine. Spine. 1985;10:21–6.
Galasko CSB. Spinal instability secondary to metastatic cancer. J Bone Joint Surg. 1991;73B:104–8.
Brihaye J, Ectors P, Lemort M, Van Houtte P. The management of spinal epidural metastases. Adv Tech Stand Neurosurg. 1988;16:121–76.
Denaro V, Di Martino A, Papalia R, Denaro L. Patients with cervical metastasis and neoplastic pachymeningitis are less likely to improve neurologically after surgery. Clin Orthop Relat Res. 2011;469:708–14.
Di Martino A, Vincenzi B, Denaro L, Barnaba SA, Papalia R, Santini D, Tonini G, Denaro V. ‘Internal bracing’ surgery in the management of solid tumor metastases of the thoracic and lumbar spine. Oncol Rep. 2009;21:431–5.
Tomita K, Kawahara N, Kobayashi T, Yoshida A, Murakami H, Akamuru T. Surgical strategy for spinal metastases. Spine. 2001;26(3):298–306.
Sundaresan N, Steinberger AA, Moore F, et al. Indications and results of combined anterior-posterior approaches for spine tumor surgery. J Neurosurg. 1996;85(3):438–46.
Damron TA, Sim FH. Surgical treatment for metastatic disease of the pelvis and the proximal end of the femur. Instr Course Lect. 2000;49:461–70.
Vecht CJ, Haaxma-Reiche H, van Putten WLJ, et al. Initial bouls of conventional versus high-dose dexamethasone in metastatic spinal cord compression. Neurology. 1989;39:1255–7.
Helweg-Larsen S, Mouridsen H, et al. Effect of high-dose dexamethasone in carcinomatous metastatic spinal cord compression treated with radiotherapy: a randomized trial. Eur J Cancer. 1994;30A:22–7.
Bauer H. Posterior decompression and stabilization for spinal metastases: analysis of sixty-seven consecutive patients. J Bone Joint Surg Am. 1997;79A:514–22.
Bilsky MH, Boakye M, Collignon F, Kraus D, Boland P. Operative management of metastatic and malignant primary subaxial cervical tumors. J Neurosurg Spine. 2005;2:256–64.
Denaro V, Denaro L, Papalia R, Marinozzi A, Di Martino A. Surgical management of cervical spine osteoblastomas. Clin Orthop Relat Res. 2007;455:190–5.
Denaro V, Gulino G, Papapietro N, Denaro L. Treatment of metastasis of the cervical spine. Chir Organi Mov. 1998;83:127–37.
Ghogawalw Z, Mansfield FL, Borges LF. Spinal radiation before surgical decompression adversely affects outcomes of surgery for symptomatic metastatic spinal cord compression. Spine. 2001;26:818–24.
Ibrahim A, Crockard A, Antonietti P, et al. Does spinal surgery improve the quality of life for those with extradural (spinal) osseous metastases? An international multicenter prospective observational study of 223 patients. J Neurosurg Spine. 2008;8:271–8.
Sundaresan N, Digiacinto GV, Hughes JE, Cafferty M, Vallejo A. Treatment of neoplastic spinal cord compression: results of a prospective study. Neurosurgery. 1991;29(5):645–50.
Sundaresan N, Rosen G, Boriani S. Primary malignant tumors of the spine. Orthop Clin N Am. 2009;40:21–36.
Vieweg U, Meyer B, Schramm J. Tumour surgery of the upper cervical spine – a retrospective study of 13 cases. Acta Neurochir. 2001;143:217–25.
Bauer HCF, Wedin R. Survival after surgery for spinal and extradural metastases. Prognostication in 241 patients. Acta Orthop Scand. 1995;66:143–6.
Landreneau RJ, Weigelt JA, Meier DE, et al. The anterior operative approach to the cervical vertebral artery. J Am Coll Surg. 1995;180:475–80.
McPhee IB, Williams RP, Swanson CE. Factors influencing wound healing after surgery for metastatic disease of the spine. Spine. 1998;23:726–32.
Kitchel SH, Eismont FJ, Green BA. Closet subarachnoid drainage for management of cerebrospinal fluid leakage after an operation to the spine. J Bone Joint Surg Am. 1989;71:984–7.
Patchell RA, Tibbs PA, Regine WF, et al. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomized trial. Lancet. 2005;366:643–8.
Riew DK, Khanna N. Treatment of cerebrospinal fluid leaks. In: Vaccaro AR, Betz RR, Zeidman SM, editors. Principles and practice of spine surgery. St. Louis: C.V. Mosby; 2002. p. 727–43.
Sorenson PS, Helweg-Larsen S, Mouridsen H, et al. Effect of high-dose dexamethasone in carcinomatous metastatic spinal cord compression treated with radiotherapy: a randomized trial. Eur J Cancer. 1994;30A:22–7.
Weigel B, Maghsudi M, Neumann C, et al. Surgical management of symptomatic spinal metastases. Postoperative outcome and quality of life. Spine. 1999;24:2240–6.
Zheng GZ, Chang B, Lin FX, Xie D, Hu QX, Yu GY, Du SX, Li XD. Meta-analysis comparing denosumab and zoledronic acid for treatment of bone metastases in patients with advanced solid tumours. Eur J Cancer Care (Engl). 2016. https://doi.org/10.1111/ecc.12541. [Epub ahead of print].
Ecker RD, Endo T, Wetjen NM, Krauss WE. Diagnosis and treatment of vertebral column metastasis. Mayo Clin Proc. 2005;80(9):1177–86.
Bilsky MH, Lis E, Raizer J, Lee H, Boland P. The diagnosis and treatment of metastatic spinal tumor. Oncologist. 1999;4:459–69.
Liu T, Xu JY, Xu W, Bai YR, Yan WL, Yang HL. Fluorine-18 deoxyglucose positron emission tomography, magnetic resonance imaging and bone scintigraphy for the diagnosis of bone metastases in patients with lung cancer: which one is the best? A meta-analysis. Clin Oncol (R Coll Radiol). 2011;23:350–8.
Maralani PJ, Lo SS, Redmond K, Soliman H, Myrehaug S, Husain ZA, Heyn C, Kapadia A, Chan A, Sahgal A. Spinal metastases: multimodality imaging in diagnosis and stereotactic body radiation therapy planning. Future Oncol. 2017;13:77–91. https://doi.org/10.2217/fon-2016-0238.
O’Sullivan GJ, Carty FL, Cronin CG. Imaging of bone metastasis: an update. World J Radiol. 2015;7(8):202–11.
Bastawrous S, Bhargava P, Behnia F, Djang DSW, Haseley DR. Newer PET application with an old tracer: role of 18F-NaF skeletal PET/CT in oncologic practice. Radiographics. 2014;34:1295–316. https://doi.org/10.1148/rg.345130061.
Denaro L, Di Martino A, et al. Cervical spine bone tumor surgery. Berlin Heidelberg: Springer; 2010. p. 165–74.
Gasbarrini A, Casadei R, Papapietro N. Il trattamento delle metastasi vertebrali. GIOT. 2012;38:188–93.
Denaro V. Stenosis of the cervical spine. Berlin: Springer; 1994.
Denaro V, Denaro L, Albo E, Papapietro N, Piccioli A, Di Martino A. Surgical management of spinal fractures and neurological involvement in patients with myeloma. Injury. 2016;47(Suppl 4):S49–53. https://doi.org/10.1016/j.injury.2016.07.047. Epub 2016 Aug 6.
Chen B, Xiao S, et al. Comparison of the therapeutic efficacy of surgery with or without adjuvant radiotherapy versus radiotherapy alone for metastatic spinal cord compression: a meta-analysis. World Neurosurg. 2015;6:1066–73.
Agabegi SS, Asghar FA, Herkowitz HN. Spinal orthoses. J Am Acad Orthop Surg. 2010;18(11):657–67.
Di Martino A, Caldaria A, De Vivo V, Denaro V. Metastatic epidural spinal cord compression. Expert Rev Anticancer Ther. 2016;12:1–10.
Zairi F, Marinho P, Bouras A, Allaoui M, Assaker R. Recent concepts in the management of thoracolumbar spine metastasis. J Neurosurg Sci. 2013;57(1):45–54.
Denaro V, Di Martino A. Cervical spine surgery: an historical perspective. Clin Orthop Relat Res. 2011;469(3):639–48. https://doi.org/10.1007/s11999-010-1752-3.
Roy-Camille R, Judet TH, Saillant G, Mamoudy P, Denaro V. Tumeurs du rachis. Encicl med-Chir Techniquee Chirurgicales. Orthopedie. 1982;11:44–165.
Denaro V. Treatment of metastases and systemic tumors of the cervical spine. Neuroorthopedics. 1988;6:101–10.
Shimizu K, Shikata J, Iida H, Iwasaki R, Yoshikawa J, Yamamuro T. Posterior decompression and stabilization for multiple metastatic tumors of the spine. Spine. 1992;17:1400–4.
Cappuccio M, Gasbarrini A, et al. Vertebroplasty in the treatment of vertebral metastases: clinical cases and review of the literature. Eur Rev Med Pharmacol Sci. 2007;11(2):91–100.
Luksanapruksa P, Buchowski JM, Zebala LP, Kepler CK, Singhatanadgige W, Bumpass DB. Perioperative complications of spinal metastases surgery. Clin Spine Surg. 2017;30(1):4–13.
Scibilia A, Terranova C, Rizzo V, Raffa G, Morelli A, Esposito F, Mallamace R, Buda G, Conti A, Quartarone A, Germanò A. Intraoperative neurophysiological mapping and monitoring in spinal tumor surgery: sirens or indispensable tools? Neurosurg Focus. 2016;41(2):E18. https://doi.org/10.3171/2016.5.FOCUS16141.
Laufer I, Iorgulescu JB, Chapman T, Lis E, Shi W, Zhang Z, et al. Local disease control for spinal metastases following “separation surgery” and adjuvant hypofractionated or highdose single-fraction stereotactic radiosurgery: outcome analysis in 186 patients. J Neurosurg Spine. 2013;18:207–14.
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Denaro, V., Di Martino, A. (2019). Spinal Metastases: Diagnosis and Management. In: Denaro, V., Di Martino, A., Piccioli, A. (eds) Management of Bone Metastases. Springer, Cham. https://doi.org/10.1007/978-3-319-73485-9_13
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