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Spinal Metastases

Updated : April 18, 2024





Background

Spinal metastases are the most prevalent malignancies of the spine, accounting for nearly 90 percent of masses detected by imaging the spine. About 20 percent of spinal metastases show with symptoms of spinal canal invasion and cord compression. Bone metastases are the most prevalent kind of spinal metastases.

In the spinal column, metastasis is most likely to be discovered in the thoracic region, and the cervical region is the least likely location. When examining spinal metastases using MRI, the lack space between vertebral discs is a defining characteristic of these lesions. This intervertebral region is usually always infected.

Diseases that metastasize to the spine can spread by a variety of mechanisms, including venous hematogenous dissemination versus arterial spread, direct tumor extension, and lymphatic spread. Hematogenous spread through Batson’s plexus system is the most prevalent route for tumor embolization and spinal invasion among the aforementioned methods.

Epidemiology

Spinal metastases are a common problem observed by oncologists while treating patients with cancer.

According to research which inspected post-mortem cadavers, the incidence of spinal metastasis in cancer patients was as significant as 70%-90% when prostate and breast cancers were one of the primary cancers.

Morbidity associated with spinal metastasis is characterized by some features such as:

  • Agonizing back pain needing large dosages of narcotic drugs for treatment
  • Bone fractures due to pathological factors
  • Hypercalcemia
  • Spinal cord compression

Infrequently, spinal metastases will germinate within the spinal cord itself, without evident bone involvement. When there is no documented history of initial cancer, it is difficult to diagnose metastatic lesions, and the proper diagnosis is frequently found after pathological testing identifies the type of tumors.

Anatomy

Pathophysiology

The general dissemination of metastases entails hematogenous spread to the vertebral body’s core. Through the early interaction of factors related to the tumor and intrinsic bone cells, such as osteoclasts, an invasion nucleus is created. More often than not, the tumor spreads posteriorly, frequently including pedicles, which is crucial information for surgical care of spinal metastases requiring spinal stability.

Due to this, screw fixation through the affected pedicles is frequently suboptimal and necessitates the union of multiple parts around the outside of the lesion. Pedicular arteries typically feed the metastatic nidus with blood, making targeted embolization by interventional treatments a possible approach.

Improving the understanding of the interactivity between metastasis and surrounding bone cells, as well as factors such as IL-6, IL-1, TGF-beta, and RANK/RANKL, has led to the development of chemical therapies for the treatment of painful bone metastasis, particularly breast and prostate, which are known to be the primary cancers.

Etiology

While all tumors have the potential to metastasize to the spinal column, some cancers are known to metastasize during fairly early stages of the disease.

Given below is a list of these cancers which are the most prevalent primary cancers that metastasize to the spine:

  • Thyroid Cancer
  • GI cancers
  • Renal Cancer
  • Prostate Cancer
  • Lung Cancer
  • Breast Cancer

Out of these cancers, at 21% breast cancer has the highest risk for metastasizing to spinal cancer, and at 2.5% thyroid cancer presents the least risk for the same.

While the precise mechanism and gene expression required for the tumor’s invasion of the spine are the subject of ongoing research, the presence of certain factors, such as RANK and RANKL, which interact with receptors to activate osteoclastic cells, appears to play a central role in establishing an invasion island.

Genetics

Prognostic Factors

The prognosis of the patient entirely depends on the site of the primary tumor. 2-year survival rates for spinal metastases can be as low 9% for lung cancer and around 44% for patients with prostate or breast cancer.

Overall, only 10%-20% of patients survive 2 years after being diagnosed with spinal metastases. This must be taken into account by the physician when determining the nature and extent of any treatment to be administered.

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

Media Gallary

References

https://www.ncbi.nlm.nih.gov/books/NBK441950/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3036978/

Spinal Metastases

Updated : April 18, 2024




Spinal metastases are the most prevalent malignancies of the spine, accounting for nearly 90 percent of masses detected by imaging the spine. About 20 percent of spinal metastases show with symptoms of spinal canal invasion and cord compression. Bone metastases are the most prevalent kind of spinal metastases.

In the spinal column, metastasis is most likely to be discovered in the thoracic region, and the cervical region is the least likely location. When examining spinal metastases using MRI, the lack space between vertebral discs is a defining characteristic of these lesions. This intervertebral region is usually always infected.

Diseases that metastasize to the spine can spread by a variety of mechanisms, including venous hematogenous dissemination versus arterial spread, direct tumor extension, and lymphatic spread. Hematogenous spread through Batson’s plexus system is the most prevalent route for tumor embolization and spinal invasion among the aforementioned methods.

Spinal metastases are a common problem observed by oncologists while treating patients with cancer.

According to research which inspected post-mortem cadavers, the incidence of spinal metastasis in cancer patients was as significant as 70%-90% when prostate and breast cancers were one of the primary cancers.

Morbidity associated with spinal metastasis is characterized by some features such as:

  • Agonizing back pain needing large dosages of narcotic drugs for treatment
  • Bone fractures due to pathological factors
  • Hypercalcemia
  • Spinal cord compression

Infrequently, spinal metastases will germinate within the spinal cord itself, without evident bone involvement. When there is no documented history of initial cancer, it is difficult to diagnose metastatic lesions, and the proper diagnosis is frequently found after pathological testing identifies the type of tumors.

The general dissemination of metastases entails hematogenous spread to the vertebral body’s core. Through the early interaction of factors related to the tumor and intrinsic bone cells, such as osteoclasts, an invasion nucleus is created. More often than not, the tumor spreads posteriorly, frequently including pedicles, which is crucial information for surgical care of spinal metastases requiring spinal stability.

Due to this, screw fixation through the affected pedicles is frequently suboptimal and necessitates the union of multiple parts around the outside of the lesion. Pedicular arteries typically feed the metastatic nidus with blood, making targeted embolization by interventional treatments a possible approach.

Improving the understanding of the interactivity between metastasis and surrounding bone cells, as well as factors such as IL-6, IL-1, TGF-beta, and RANK/RANKL, has led to the development of chemical therapies for the treatment of painful bone metastasis, particularly breast and prostate, which are known to be the primary cancers.

While all tumors have the potential to metastasize to the spinal column, some cancers are known to metastasize during fairly early stages of the disease.

Given below is a list of these cancers which are the most prevalent primary cancers that metastasize to the spine:

  • Thyroid Cancer
  • GI cancers
  • Renal Cancer
  • Prostate Cancer
  • Lung Cancer
  • Breast Cancer

Out of these cancers, at 21% breast cancer has the highest risk for metastasizing to spinal cancer, and at 2.5% thyroid cancer presents the least risk for the same.

While the precise mechanism and gene expression required for the tumor’s invasion of the spine are the subject of ongoing research, the presence of certain factors, such as RANK and RANKL, which interact with receptors to activate osteoclastic cells, appears to play a central role in establishing an invasion island.

The prognosis of the patient entirely depends on the site of the primary tumor. 2-year survival rates for spinal metastases can be as low 9% for lung cancer and around 44% for patients with prostate or breast cancer.

Overall, only 10%-20% of patients survive 2 years after being diagnosed with spinal metastases. This must be taken into account by the physician when determining the nature and extent of any treatment to be administered.

https://www.ncbi.nlm.nih.gov/books/NBK441950/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3036978/