Sternal metastasis - the forgotten column and its effect on thoracic spine stability
Robert Pearse Piggott1, Mark Curtin1, Sudarshan Munigangaiah1
1Robert Pearse Piggott, Mark Curtin, Sudarshan Munigangaiah, Mutaz Jadaan, John Patrick McCabe, Aiden Devitt, Department of Trauma and Orthopaedic Surgery, Galway University Hospitals, the West/North West Hospitals Group, HSE, Galway H91 YR71, Ireland.
Abstract:
Sternal metastases are not studied extensively in the literature. There is a paucity of information on their role in metastatic disease. The concept of the fourth column was described by Berg in 1993, and has been proven in case report, clinically and biomechanical studies. The role of the sternum as a support to the thoracic spine is well documented in the trauma patients, but not much is known about its role in cancer patients. This review examines what is known on the role of the fourth column. Following this we have identified two likely scenarios that sternal metastases may impact management: (1) sternal pathological fracture increases the mobility of the semi-rigid thorax with the loss of the biomechanical support of the sternum-rib-thoracic spine complex; and (2) a sternal metastasis increases the risk of fracture, and while being medical treated the thoracic spine should be monitored for acute kyphosis and neurological injury secondarily to the insufficiency of the fourth column.
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