Holistic Approach to the Diagnosis and Treatment of Patients with Tumor Metastases to the Spine
Abstract
:Simple Summary
Abstract
1. Introduction
2. Scales Assessing the Severity of the Disease, Algorithms Setting Out Treatment Strategies, and Qualifications for the Surgical Treatment
3. Diagnostics
3.1. Imaging
3.1.1. X-ray Examination
3.1.2. Magnetic Resonance Imaging (MRI)
3.1.3. Computed Tomography (CT)
3.1.4. Bone Scintigraphy
3.2. Invasive Diagnostics—Biopsy
4. The Ways of the Surgical Treatment
5. Radiotherapy
6. Other Ways of Treatment
7. Therapeutic Perspectives
8. Prognosis
9. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Type of Spine Metastases | ||
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Osteoclastic | Osteoblastic | |
Primary tumor | e.g., lungs, kidneys, multiple myeloma | e.g., prostate |
Factors secreted by neoplasm cells | IL-1 IL-6 IL-8 IL-10 IL-11 TGF-α TGF-β PTHrP PgE2 TNF CSF-1 GM-CSF M-CSF VEGF EGF | ET-1 TGF-β PDGF BMP IGF FGF CXCL-1 uPA PSA |
Factors released from the bone microenvironment | TGF-β | |
FGF | ||
IGF | ||
BMP | ||
PDGF | ||
OPG | ||
HGF | ||
IL-6 | ||
CTGF | ||
M-CSF | ||
VEGF | ||
PTHrP activins |
Scales Assessing the Severity of the Disease | |
---|---|
The Name of the Scale | What Does the Scale Evaluate? |
The Karnofsky scale | functional patient’s condition |
ASA Physical Status Classification System | operational risk |
the Frankel scale, the American Spinal Injury Association Impairment Scale (AIS) | patient’s neurological condition |
The Visual Analogue Scale (VAS) | pain assessment |
Spinal Instability Neoplastic Score (SINS), De Wald scale, Tomita’s surgical classification, Harrington scale, epidural spinal cord compression scale (ESCC), Weinstain–Boriani–Biagini classification, Asdourian scale, Tomita scale, Tokuhashi scale | assessment neoplastic lesions, their advancement and localization in bone and ligamentous structures of the spine and the spinal canal |
Tokuhashi scale, modified Bauer scale | predicted survival time of a patient with neoplastic metastases to the spine |
Approach | Level of Spine | Description |
---|---|---|
anterior | the upper part of the cervical spine, craniospinal junction: the base of the skull, atlas (C1), and axis (C2) | through the posterior wall of the pharynx, mandibular (with or without cut of the mandible) |
C3 to C7 | proposed by Clovard Smith and Robinson—in front of the anterior edge the sternocleidomastoid muscle | |
thoracic vertebrae | the anterior approach to the thoracic vertebrae is complex from Th2 to Th5 due to the limitations of the sternum (the need for sternotomy) and to the Th10 to L1 thoracolumbar spine junction caused by diaphragm attachments (the need to connect the post-pleural and retroperitoneal entrances) | |
lumbar shafts L1 to L4 | provided by retroperitoneal access; the peritoneal approach enables surgery in the L5 vertebrae and sacral segments | |
peritoneal | L5 sacral segments | - |
posterior | - | routinely used laminectomy, which makes way to open the vertebral canal and exposes posterior surface of spinal cord |
lateral | - | laminectomy and total excision of pedicles of vertebral arch at the same time enable lateral approach to vertebral canal and show lateral surface of spinal cord (intrapedicular approach); the excision of the intervertebral joint and head of rib in thoracic spine expose lateral side of vertebral body (lateral approach—costotransversectomy and postpleural lateral approach) |
posterolateral | - | the body of the thoracic vertebra can be visualized via a posterolateral thoracotomy |
en block | - | tumor excision in one piece with margin of surrounding tissue; the character of metastatic tumor and localization in the spine rarely allows the use of this kind of resection; usually debulking is used, the aim is to remove the pressure of the spinal cord |
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Nowak, H.; Szwacka, D.M.; Pater, M.; Mrugalski, W.K.; Milczarek, M.G.; Staniszewska, M.; Jankowski, R.; Barciszewska, A.-M. Holistic Approach to the Diagnosis and Treatment of Patients with Tumor Metastases to the Spine. Cancers 2022, 14, 3480. https://doi.org/10.3390/cancers14143480
Nowak H, Szwacka DM, Pater M, Mrugalski WK, Milczarek MG, Staniszewska M, Jankowski R, Barciszewska A-M. Holistic Approach to the Diagnosis and Treatment of Patients with Tumor Metastases to the Spine. Cancers. 2022; 14(14):3480. https://doi.org/10.3390/cancers14143480
Chicago/Turabian StyleNowak, Hanna, Dominika Maria Szwacka, Monika Pater, Wojciech Krzysztof Mrugalski, Michał Grzegorz Milczarek, Magdalena Staniszewska, Roman Jankowski, and Anna-Maria Barciszewska. 2022. "Holistic Approach to the Diagnosis and Treatment of Patients with Tumor Metastases to the Spine" Cancers 14, no. 14: 3480. https://doi.org/10.3390/cancers14143480