Spinal Metastases
Spinal Metastases
What Is It?
The appearance of metastases in the spinal column (also referred to as metastasis to the back) is quite common in patients who have already developed cancer in another organ of the body. The spinal column is the third most common “site” for cancer cells to metastasize to, after the lungs and the liver.
The most common cancers that metastasize to the spine are those of the lungs, breast, gastrointestinal tract, prostate, kidneys, etc.
Symptoms of spinal tumors
When a spinal tumor is caused by metastasis, symptoms usually occur, depending on many factors.
These factors include the exact location, the growth rate, spinal cord compression, and stability problems in the spine that may occur.
Among the symptoms, pain is predominant, which does not improve even with lying down. In fact, pain due to malignancy is usually more intense at night (nocturnal pain). The intensity of the pain is such that it prevents patients from getting out of bed and becoming active. Weakness, numbness, and difficulty walking are common symptoms and sometimes appear suddenly (paralysis).
Treatment
Spinal Metastases
Surgery involves the decompression of neural elements through partial or total (when life expectancy is good) removal of the tumor.
Because there is always instability in the vertebrae and the spinal cord’s integrity is at risk, spinal fusion is also performed at the same time. If life expectancy is not long and the main problem is back pain (without paresis/paralysis), then the method of kyphoplasty is chosen for immediate pain relief.
Anterior cervical spinal fusion
If a patient with metastatic spinal cord compression in the cervical spine presents with symptoms of myelopathy or instability, then surgery is the only option. Anterior cervical corpectomy and spinal fusion (ACCF) is a common procedure in cases of spinal tumors.
The entire tumor and a portion of the vertebra(e) are removed and usually replaced with a cage. The vertebrae are stabilized with a metal plate. The procedure is called corpectomy, and sometimes additional posterior fusion may be needed. The latter is always recommended when the corpectomy is extensive and at the same time the life expectancy is relatively good.
Vertebroplasty – Kyphoplasty
Vertebroplasty is a method in which a fracture is stabilized by injecting acrylic cement. Kyphoplasty is essentially the same method, with the use of a balloon that inflates to create the space where the cement will be placed.
The main indications for choosing these methods are osteoporotic fractures, metastatic disease, multiple myeloma, and hemangioma.
Minimally invasive spinal fusion
With this technique, spinal fusion is achieved through smaller incisions/holes over each vertebra. The procedure is performed without causing iatrogenic injury to the paraspinal muscles. Total surgery time does not exceed two hours and hospitalization does not last more than one day. An advantage is the reduced rate of complications from the surgical wound and the faster healing that is necessary for the start of chemotherapy and radiotherapy where needed.
In addition to the above techniques, the patient may need to undergo chemotherapy or radiotherapy.
Chemotherapy aims to control the disease at its source (primary lesion). Radiotherapy, on the other hand, prevents cancer cells from multiplying locally – that is, at the site where the metastasis has occurred.
