Spinal Metastasis : Review Of Treatment With Case Illustration

Abstract

Metastatic disease is on the rise as cancer patients live longer due to advancements in oncologic treatments. Bone is the third commonest site for metastasis after lung and liver  and the spine is the commonest site for bony metastasis. 80 percent of metastasis arises from breast, lung and prostate. Metastasis present with mechanical or biologic back pain and  radiculopathy or myelopathy. MRI is the imaging modality of choice and is augmented by CT scanning for bony anatomy. Treatment comprises three modalities : radiation, surgery and chemotherapy. Conventional external beam radiation  is used to treat tumors with radiosensitive histology. SRS provides durable local control for tumors with radioresistant histology. Surgery is recommended to decompress the cord from radioresistant tumor, stabilize unstable spine, recalcitrant  radicular pain and if there is a pathologic fracture with bone in the canal. Percutaneous Kyphoplasty or vertebroplasty for compression fracture reduces pain and can improve neurology. Instrumentation through an anterior or posterior approach stabilizes an unstable spine. Separation surgery with or without instrumentation is required for high grade cord compression in radioresistant histology. Decision making for treatment relies on the NOMS framework. We present a patient with  C6 vertebra follicular thyroid metastasis managed at our unit. A review of treatment using the NOMS framework is made.