Metastatic Spine Tumors Classification
and Indications for Surgery
Overview
It is not surprising that the incidence of spinal metastases is increasing since the spine is the most common site for bone metastases, and there are improvements in medical treatment, as well as an increasingly older population with longer life expectancy.
Spinal metastases are present in as many as 70% of cancer patients, and up to 10% of cancer patients experience metastatic cord compression. Breast, lung, renal, prostate, thyroid, melanoma, myeloma, lymphoma, and colorectal cancer are among the most frequent tumor types that affect the spine.
Survival times have increased with advancements in chemotherapy, radiotherapy, and hormonal therapies, and it is possible that patients’ expectations have also risen. Advancements in surgical techniques, along with technological innovations, have enhanced our doctor’s ability to manage spinal metastases more efficiently.
Surgery can effectively improve mechanical stability, cord compression, and pain. Modern surgery offers superior outcomes compared to radiotherapy alone and can often improve the quality of life after the procedure.
When considering surgery as an option, it is important to keep in mind that the life expectancy of patients with metastatic spinal tumors is typically determined by the stage and type of the tumor. Therefore, the decision to undergo surgery should not negatively impact the patient’s remaining quality of life.
The potential benefits of surgery must be carefully weighed against the complication rate, which can be as high as 20-30%. When the patient is expected to live for more than 3 months, surgery may be considered.
Classification of metastatic spinal tumors
It is essential to perform staging, unless surgery is urgently required, such as in patients experiencing rapid neurological function decline. Some of these classification systems are centered around the patient’s overall tumor burden and functional abilities, whereas others concentrate on the anatomical scope of tumor involvement. This classification is based on three factors:
- Speed at which the primary tumor is growing
- Number of bone metastases
- Presence of visceral metastases
There is a strong correlation between the histology of the primary tumor and the patient’s survival rate, whether they undergo surgery or receive medical treatment. Patients with myeloma, breast, prostate, and thyroid cancers tend to have longer survival times.
Paralysis may be linked to a higher tumor burden or accelerated tumor growth, rather than being directly or distinctly associated with poor survival. Patients whose metastases originate from an unknown primary tumor may have a poorer prognosis compared to those with identifiable tumors.
Anatomical classification systems may be valuable for surgical preparation, but they may be more appropriate for assessing primary tumors than metastases. Typically, to determine the appropriate surgical approach, more information beyond the anatomical location of the tumor is required.
Literature describes a classification system for spinal tumors that often requires prior knowledge of the histology and degree of tumor spread throughout the body. However, this information may not always be available at the time of presentation.
Prognostic Classification And Surgical Planning
Patients who have a highly favorable prognosis should receive extensive excision, while those with moderate scores should receive marginal or intralesional excision and palliative surgery. The group with the poorest prognosis should receive non-surgical supportive care, and no surgical intervention.
Recommendations of the Global Spine Tumor Study Group
The incidence of complications in patients undergoing spinal metastases surgery may reach 25%, with wound infection being the most prevalent complication.
The prognosis of a patient is generally dependent on the extent of metastasis, making surgery beneficial only if it can enhance the patient’s quality of life. As the complexity and extent of a surgical procedure increase, the probability of complications also increases. Hence, there comes a point where a trade-off must be made between the advantages and hazards of the surgery.
Since surgery is mostly palliative for spinal metastases patients, evaluating their overall quality of life may be more significant than physical scores and neurological outcome measures. As a result, the GSTSG recommends employing quality of life assessments for all patients who undergo surgery.
Literature has indicated that surgery for metastases can lead to enhancements in quality of life, with as many as 80% of patients feeling content or very content with the decision to undergo the procedure.
The most significant enhancements are observed in the pain domain, although surgery may also result in improvements in nonspecific symptoms like tiredness, nausea, anxiety, and appetite. For all patients with metastatic disease, the GSTSG employs the Euroqol EQ5D appraisal tool.
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Do you have more questions?
What symptoms should I watch out for if I suspect a spinal tumor?
Symptoms include back pain, neurological deficits (such as numbness or weakness), difficulty walking, loss of bowel or bladder control, and unexplained weight loss.
How are spinal tumors diagnosed?
Diagnosis typically involves imaging studies like MRI or CT scans, and may include biopsy to determine the nature of the tumor.
What are the treatment options for spinal tumors?
Treatment options include surgery, radiation therapy, chemotherapy, and newer treatments like stereotactic radiotherapy and targeted therapies.
What is the survival rate for patients with spinal tumors?
Survival rates vary widely based on the type of tumor and its stage. Advances in treatment have led to longer survival times for many patients.
How effective are the current treatments for spinal tumors?
Effectiveness varies depending on the type, location, and stage of the tumor, but advancements in treatment have improved survival rates and quality of life.
Can spinal tumors be cured?
Some spinal tumors, especially benign ones, can be cured with appropriate treatment. Malignant tumors may not be curable but can often be managed effectively.
What are the potential complications of spinal tumor treatments?
Complications can include infection, bleeding, nerve damage, and reactions to anesthesia or chemotherapy.
What is spinal cord compression and how is it related to spinal tumors?
Spinal cord compression occurs when a tumor presses on the spinal cord, leading to pain, neurological deficits, and sometimes paralysis. It is a medical emergency requiring prompt treatment.
How do spinal tumors cause pain?
Pain can result from the tumor pressing on nerves or the spinal cord, causing inflammation, or leading to spinal instability or fractures.
What role does physical therapy play in the treatment of spinal tumors?
Physical therapy can help improve mobility, strengthen muscles, reduce pain, and enhance overall quality of life.
Are there any lifestyle changes I should make if I have a spinal tumor?
Maintaining a healthy lifestyle, including regular exercise, a balanced diet, and avoiding smoking, can help improve overall health and aid in recovery.
How do I cope with the mental and emotional impact of having a spinal tumor?
Seeking support from mental health professionals, joining support groups, and staying connected with loved ones can help manage the emotional burden.
What is the role of self-assessment tools in managing spinal tumors?
Self-assessment tools enable patients to directly report their health status, helping healthcare providers better understand the patient’s experience and adjust treatment plans accordingly.
What is the role of self-assessment tools in managing spinal tumors?
Self-assessment tools enable patients to directly report their health status, helping healthcare providers better understand the patient’s experience and adjust treatment plans accordingly.
How do bone metastases affect the spine?
Bone metastases can weaken the spine, leading to fractures, spinal instability, and compression of the spinal cord or nerves.
What is hypercalcemia and how is it related to spinal tumors?
Hypercalcemia is a condition of elevated calcium levels in the blood, often caused by bone metastases, leading to symptoms like nausea, vomiting, confusion, and cardiac issues.
What are the psychosocial impacts of having a spinal tumor?
Psychosocial impacts include anxiety, depression, social isolation, and changes in family dynamics and employment status.
Why is there a lack of standardized outcome measures for spinal tumor patients?
The variability in tumor types, locations, and individual patient conditions makes it challenging to develop universally applicable outcome measures.
How does the International Classification of Functioning, Disability, and Health (ICF) help in managing spinal tumors?
The ICF provides a comprehensive framework for evaluating the impact of spinal tumors on a patient’s life, helping to standardize assessments and improve treatment planning.
What are bisphosphonates and how do they help with spinal tumors?
Bisphosphonates are medications that help strengthen bones and reduce the risk of fractures in patients with bone metastases.
What advancements have been made in the surgical treatment of spinal tumors?
Advances include minimally invasive techniques, better imaging for preoperative planning, and enhanced postoperative care, which improve outcomes and reduce recovery times.
What is antiangiogenic tumor modulation?
Antiangiogenic therapy aims to inhibit the growth of new blood vessels that tumors need to grow, thereby slowing tumor progression.
How can stereotactic radiotherapy benefit spinal tumor patients?
Stereotactic radiotherapy delivers precise, high-dose radiation to the tumor while sparing surrounding healthy tissue, offering effective treatment with fewer side effects.
What should I discuss with my orthopedic surgeon during a consultation about spinal tumors?
Discuss the type and stage of the tumor, treatment options, potential risks and benefits, expected outcomes, pain management strategies, and the impact on quality of life.
I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.
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