Abstract
We investigated whether the intensity of cancer pain differs for malignant tumors that have spread to anterior or anterolateral/lateral portions of the vertebral body. We hypothesize that tumor spread to the anterolateral/lateral vertebral body elicits more serious pain due to increased irritation of the spinal nerve. The selection criteria were as follows: (1) advanced or metastatic solid tumor; (2) radicular pain without extremity weakness; (3) malignant lesions anteriorly, anterolaterally, or laterally located at the vertebral body either spread locoregionally or over a greater distance via metastasis based on CT scan diagnosis; and (4) patient needs to use opioids for pain relief. Severe spinal pain intensity was defined as spinal pain for which patients required either strong opioids or spinal irradiation for relief. Eighty-six patients were enrolled in the study. Bone lesions were mainly osteolytic. Thirty-nine tumors spread to the vertebral body in the anterior direction, and 47 in the anterolateral/lateral direction. Severe pain intensity related to vertebral body lesions was due to anterolateral/lateral spread, primary sites of nonurothelial carcinoma, metastatic vertebral lesions, multiple lesions within a vertebrum, and location within the cervical-thoracic spine. In conclusion, patients with tumor spread to the anterolateral/lateral portion of vertebrae bodies based on CT scan diagnosis experienced severe cancer pain. These patients needed strong opioids or palliative spinal irradiation for pain relief.
Highlights
Malignant tumors located laterally or anterolaterally within the vertebral body can cause pain because they involve the ventral ramus, which is the anterior division of a spinal nerve located at the anterolateral aspect of the spinal cord
We investigated whether the intensity of cancer pain is different for malignant tumors that spread to anterior or anterolateral/lateral portions of the vertebral body based on computed tomography (CT) scan diagnosis
Eighty-six patients with advanced or metastatic solid tumors were enrolled. e population consisted of 58 men and 28 women who ranged in age from 25 to 89 years
Summary
Malignant tumors located laterally or anterolaterally within the vertebral body can cause pain because they involve the ventral ramus, which is the anterior division of a spinal nerve located at the anterolateral aspect of the spinal cord. E ventral rami exit the anterolateral vertebral body and converge to form the nerve plexuses (cervical, brachial, and lumbosacral). Intercostal nerves arise from the ventral rami of the thoracic spinal nerves. Radiculopathy is due to compressed or irritated nerve roots, which may cause pain, numbness, tingling, or weakness along the course of the nerve [1, 2]. Radicular pain is characterized by pain radiating along the dermatome of a nerve [3]. Back pain and radicular pain are the most common initial presentations of a malignant spinal cord compression [4].
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