Surgical Management of Spinal Metastases

Abstract

The spine is the most common site of skeletal metastases. Breast cancer is the most common primary tumor that metastasize to the spine (30%). The lumbar spine is the commonest site to be involved by secondaries (56%).

The dorsal spine is the most common site associated with neurological deficits, due to the relative narrowing of the spinal canal, and the precarious blood supply of the cord in this region.

Spinal metastases may be asymptomatic. The most common clinical presentation of spinal metastases is severe back pain, less commonly a neurological deficit. In diagnosing spinal metastases, radioactive isotope scannmg IS the most sensitive tool, although it has the disadvantage of reflection of multiple areas of vertebral involvement without clarifying the exact level of vertebral affection. M.R.I has the great advantage of delineating the spinal cord, the C.S.F., the spinal canal with different tissue resolution, so the exact degree and site of cord compression can be determined.

Biopsy still remains the surest way to diagnose spinal metastases, as well as grading and radiosensitivity of the tumor. Biopsy may be accomplished by closed means (needle biopsy) which is successful in (61%) of cases, or by open surgical sampling (incisional or excisional biopsy) which is more dependable in establishing the diagnosis.

Accurate assessment of spinal cord stability, pain, and neurologic function Js essential to any rational approach to metastatic disease of the spine. The Harrington classification is useful in terms of selecting treatment options and planning appropriate interventional and adjuvant Therapy. For milder cases, with bone involvement in the absence of structural deformity, adjuvant therapy usually is appropriate.