Evaluation of the role of surgery in treatment of metastases of the dorsal and lumbar spine

Abstract

Metastatic neoplasms are by far the most common malignant bone tumors. The common primary tumors for bone metastases are breast, prostate, lung, thyroid and kidney. The thoracic spinal column is most commonly involved followed by the lumbar region, pelvis, femur, rib and skull.

Metastases involves the release of cells from the primary tumor, dissemination to distant sites, arrest in the microcirculation of organs, extravasation, infiltration into the storma of those organs and the survival and growth into new tumor foci. The outcome of the process has been shown to depend on host factors and tumor cell properties

Early diagnosis and detection of spinal metastasis is the most important factor in their management. Spinal metastases conunonly present with back pain and or neurologic deficit secondary to cord or cauda compressiOn. The aim of the investigation work up is to detect the pathology and assess its effects on the spinal stability and nervous tissue. Plain radiographs, CT scan, MRI, bone scan and vertebral biopsy are investigations to assessment of the extent of spinal metastases.

The spine has a load bearing and nerve protecting function. Failure of its structural integrity as a result of vertebral metastases often brings about sever pain or paralysis.