Surgical Treatment of Metastatic Tumors of the Spine

Abstract

Metastatic .neoplasms are by far the most common malegnant tumors of bone specially to the vertebral column. The commonest primary tumors responsible for spinal metastases are breast, lung, prostate, kidney, thyroid, and gastrointestinal tract. The thoracic and thoracolumbar spine _./ are most commonly involved followed by lumbar and cervical regions. Vertebral body is affected 20 times more than posterior elements.

Dissemination of metastases to the spine occures mainly through hematogenous pathway; arterial spread through systemic circulation as lung cancer or venous spread through Batson plexuses of veins as prostate and breast cancers and arrest in microcirculation in vertebral body trabeculae then growth as a new tumor focus. The site of embolization depend on host and tumor cell factors and other mechanisms such as tissue specificity, cascade system, and closed loop circulation system.

The spine has a load bearing and nerve protecting function. Growing of metastases leads to neural compression of nerve roots, spinal cord, or coda equina and its progression can make failure of structural integrity which leads to distructive collapse of vertebral bone resulting in sever back pain of different types, neural dysfunction, and spinal deformation.