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The treatment of spinal metastases
Karl-Stefan Delank1, Clemens Wendtner, Hans Theodor Eich
1Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universität Köln, Köln, Germany. stefan.delank@uk-koeln.de
Background:
The rising life expectancy of cancer patients has led to a greater need for treatment of spinal metastases. Interdisciplinary collaboration is important so that each patient's treatment can be properly tailored to the overall prognosis. The main factors to be considered are the histology of the primary tumor, potential spinal instability, and compression of neural structures.
Methods:
We discuss the treatment options for spinal metastases on the basis of a selective literature review and our own extensive experience in an interdisciplinary tumor center.
Results:
For spinal canal compression or impending spinal instability, the treatment of choice is decompression and stabilization, by either a dorsal approach (lumbar and thoracic spine) or a ventral approach (cervical spine). Radical ventral tumor resection is indicated only for solitary metastases in patients with a favorable long-range prognosis. If the tumor is radiosensitive, radiotherapy is given either as adjuvant treatment after surgery or as the primary treatment for multiple spinal metastases in the absence of an acute neurological deficit. Various fractionation schemes with different total radiation doses are used. Bisphosphonate treatment is an integral component of the overall treatment strategy.
Conclusion:
The treatment of spinal metastases requires interdisciplinary collaboration and must be tailored to each patient's overall prognosis.