Surgical Treatment Options for Metastatic Spinal Tumors

Abstract

Introduction Metastatic spinal tumors are surgically challenging lesions. Around 10 to 20% of all cancer patients develop symptoms of bone metastases that are most common in spine and pelvis. The metastatic tumors can involve any part of the spinal column, invade the spinal canal, and spread to the neighboring tissue and to the mediastinal or retroperitoneal space. The indication for surgery is usually rapidly progressive spinal cord compression as an initial manifestation of a malignant disease. Methods Most of the patients with spinal metastatic disease present with the local pain and/or neurological deterioration. The patients are assessed regarding the severity of the pain and neurological deficit, and there are several systems that are helping us classify the patients (Karnofsky performance score, Tomita and Tokuhashi predicting survival scores, etc.). The main goals of surgical treatment of metastases are preservation and improvement of neurological functions, pain control, and stabilization of the spine. The surgery usually involves a multidisciplinary approach. The type of operative and postoperative treatment depends on the histological nature of the tumor, extension of the tumor, and integrity of the bony elements of the spine. The prognosis and extension of the primary disease and other comorbidities is also to be considered. Variety of surgical options include: microsurgical decompression of the neural structures, posterior, anterior, or lateral fusion, corpectomy, vertebroplasty, or kyphoplasty, and combination of those options. Results In the last years in our department, a single-step posterolateral approach was increasingly utilized, consisting of maximal tumor resection, combined with stabilization. Favorable clinical results and good palliation were achieved in most patients. The additional oncological therapy is usually necessary. Conclusion The prognosis for most patients with metastatic spinal tumors is still very unpredictable. Individual treatment strategy is mandatory for each patient and usually consists of multidisciplinary approach. The surgery has moved from multiple-steps to one-step surgery in the last years and with this a favorable clinical results could be achieved.