Abstract
Metastatic spine disease is the most common neoplastic process to affect the human spine. If left untreated, the prognosis of this disease is poor, with pain and progressive loss of neurological function resulting from disease progression. The goals of treatment for spinal metastases include alleviation of pain, control of local tumor burden, stabilization or reversal of neurological dysfunction and even cure of the neoplastic process. Surgery, radiotherapy and radiosurgery all play a role in the management of spinal metastases, and the indications and outcomes for each of these treatment options is discussed in the following chapter. With appropriate and timely intervention, the treatment of metastatic spine disease can be highly beneficial to the patient, with improvements seen in both quality of life and length of survival.
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References
Abrams HL, Spiro R, Goldstein N (1950) Metastases in carcinoma. Cancer 3:74–85
Bartels RHMA, Feuth T, van der Maazen R, Verbeek ALM, Kappelle AC, Grotenhuis JA, Leer J (2007) Development of a model with which to predict the life expectancy of patients with spinal epidural metastasis. Cancer 110:2042–2049
Boriani S, Saravanja D, Yamada Y, Varga P, Biagini R, Fisher CG (2009) Challenges of local recurrence and cure in low grade tumors of the spine. Spine 34:S48–S57
Falicov A, Fisher CG, Sparkes J, Boyd MC, Wing PC, Dvorak MF (2006) Impact of surgical intervention on quality of life in patients with spinal metastases. Spine 31:2849–2856
Fehlings MG, David KS, Vialle L, Vialle E, Setzer M, Vrionis FD (2009) Decision making in the surgical treatment of cervical spine metastases. Spine 34:S108–S117
Fehlings MG, Furlan J, Bilsky M (2011). Defining oncologic instability of the cervical spine -can the available evidence guide clinical practice? Presented at the Canadian Spine Society Annual Meeting, Lake Louise, March, 2010
Fisher CG, DiPaola CP, Ryken TC, Bilsky MH, Shaffrey CI, Berven SH, Harrop JS, Fehlings MG, Boriani S, Chou D, Schmidt MH, Polly DW, Biagini R, Burch S, Dekutoski MB, Ganju A, Gerszten PC, Gokaslan ZL, Groff MW, Liebsch NJ, Mendel E, Okuno SH, Patel S, Rhines LD, Rose PS, Sciubba DM, Sundaresan N, Tomita K, Varga PP, Vialle LR, Vrionis FD, Yamada Y, Fourney DR (2010a) A novel classification system for spinal instability in neoplastic disease. Spine 35:E1221–E1229
Fisher CG, Saravanja DD, Dvorak MF, Rampersaud R, Clarkson PW, Hurlbert J, Fox R, Zhang H, Lewis S, Riaz S, Ferguson PC, Boyd MC (2010b) Surgical management of primary bone tumors of the spine: validation of an approach to enhance cure and reduce local recurrence. Spine. doi:10.1097/BRS.0b013e3181e502e5
Fisher CW, Burch M, Buckley J (2011) Instability and impending instability of the thoracolumbar spine in patients with spinal metastases: a systematic review. Spine. doi:10.3892/ijo_00000818
Fujibayashi S, Neo M, Miyaki K, Nakayama T, Nakamura T (2010) The value of palliative surgery for metastatic spinal disease: satisfaction of patients and their families. Spine J 10:42–49
Gerszten PC, Burton SA, Ozhasoglu C, Welch WC (2007) Radiosurgery for spinal metastases: clinical experience in 500 cases from a single institution. Spine 32:193–199
Gerszten PC, Mendel E, Yamada Y (2009) Radiotherapy and radiosurgery for metastatic spine disease. Spine 34:S78–S92
Ghogawala Z, Mansfield FL, Borges LF (2001) Spinal radiation before surgical decompression adversely affects outcomes of surgery for symptomatic metastatic spinal cord compression. Spine 26:818–824
Harel R, Angelov L (2010) Spine metastases: current treatments and future directions. Eur J Cancer. doi:10.1016/j.ejca.2010.04.025
Hessler C, Burkhardt T, Raimund F, Regelsberger J, Vettorazzi E, Madert J, Eggers C (2009) Dynamics of neurological deficit after surgical decompression of symptomatic vertebral metastases. Spine 34:566–571
Ibrahim A, Crockard A, Antonietti P, Boriani S, Bunger C, Gasbarrini A, Grejs A, Harms J, Kawahara N, Mazel C, Melcher R, Tomita K (2008) Does spinal surgery improve quality of life for those with extradural (spinal) osseous metastases? An international multicenter prospective observational study of 223 patients. J Neurosurg Spine 8:271–278
Itshayek E, Yamada J, Bilsky M, Schmidt M, Shaffrey C, Gerszten P, Polly D, Gokaslan Z, Varga PP, Fisher CG (2010) Timing of surgery and radiotherapy in the management of metastatic spine disease: a systematic review. Int J Oncol 36:533–544
Kawahara N, Tomita K, Murakami H, Demura S, Satomi K, Atomi Y (2009) Total en bloc spondylectomy and a greater omentum pedicle flap for a large bone and soft tissue defect: solitary lumbar metastasis from renal cell carcinoma. J Orthop Sci 14:830–836
Loblaw DA, Laperriere NJ, Mackillop WJ (2003) A population-based study of malignant spinal cord compression in Ontario. Clin Oncol 15:211–217
Maranzano E, Bellavita R, Rossi R, De Angelis V, Frattegiani A, Bagnoli R, Mignogna M, Beneventi S, Lupattelli M, Ponticelli P, Biti GP, Latini P (2005) Short-course versus split-course radiotherapy in metastatic spinal cord compression: results of a phase III, randomized, multicenter trial. J Clin Oncol 15:3358–3365
Mendel E, Bourekas E, Gerszten P, Golan J (2009) Percutaneous techniques in the treatment of spine tumors. Spine 34:S93–S100
Patchell RA, Tibbs PA, Regine WF, Payne R, Saris S, Kryscio RJ, Mohiuddin M, Young B (2005) Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic spine cancer: a randomised trial. Lancet 366:643–648
Perrin RG, Laxton AW (2004) Metastatic spine disease: epidemiology, pathophysiology and evaluation of patients. Neurosurg Clin N Am 15:365–373
Polly DW, Chou D, Sembrano JN, Ledonio CGT, Tomita K (2009) An analysis of decision making and treatment of thoracolumbar metastases. Spine 34:S118–S127
Sakaura H, Hosono N, Mukai Y, Ishii T, Yonenobu K, Yoshikawa H (2004) Outcome of total en bloc spondylectomy for solitary metastasis of the thoracolumbar spine. J Spinal Disord Tech 17:297–300
Street J, Fisher C, Sparkes J, Boyd M, Kwon B, Paquette S, Dvorak M (2007) Single-stage posterolateral vertebrectomy for the management of metastatic disease of the thoracic and lumbar spine: a prospective study of an evolving technique. J Spinal Disord Tech 20:509–520
Sundaresan N, Boriani S, Okuno S (2009) State of the art management in spine oncology. Spine 34:S7–S20
Taneichi H, Kaneda K, Takeda N, Abumi K, Satoh S (1997) Risk factors and probability of vertebral body collapse in metastases of the thoracic and lumbar spine. Spine 22:239–245
Thomas KC, Nosyk B, Fisher CG, Dvorak M, Patchell RA, Regine WF, Loblaw A, Bansback N, Guh D, Sun H, Anis A (2006) Cost-effectiveness of surgery plus radiotherapy versus radiotherapy alone for metastatic epidural spinal cord compression. Int J Radiat Oncol Biol Phys 66:1212–1218
Tokuhashi Y, Ajiro Y, Umezawa N (2008) Outcome of treatment for spinal metastases using scoring system for preoperative evaluation of prognosis. Spine 34:69–73
Van der Linden YM, Dijkstra SPDS, Vonk EJA, Marijnen CAM, Leer JH (2005) Prediction of survival in patients with metastases in the spinal column. Cancer 103:320–328
Wong DA, Fornasier VL, MacNabb I (1990) Spine metastases: the obvious, the occult, and the impostors. Spine 15:1–4
Yamazaki T, McLoughlin GS, Patel S, Rhines LD, Fourney DR (2009) Feasibility and safety of en block resection for primary spine tumors. Spine 34:S31–S38
Young RF, Post EM, King GA (1980) Treatment of spinal epidural metastases. J Neurosurg 53:741–748
Zaikova O, Giercksky K-E, Fossa SD, Kvaloy S, Johannesen TB, Skjeldal S (2009) A population-based study of metastatic spine disease in South-East Norway. Clin Oncol 21:753–759
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Nikolakis, M.A., Fisher, C.G. (2012). Metastatic Spine Disease: Indications, Timing, and Outcomes for Surgery and Radiation Therapy. In: Hayat, M. (eds) Tumors of the Central Nervous System, Volume 6. Tumors of the Central Nervous System, vol 6. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-2866-0_18
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DOI: https://doi.org/10.1007/978-94-007-2866-0_18
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