Spinal Metastases

Spinal Metastases Sohail Bajammal, MBChB, MSc, FRCS(C) October 6, 2008 Spine Fellows Rounds

Acknowledgement ,[object Object]

Once upon a time… ,[object Object]

Total en bloc spondylectomy ,[object Object]

On the other hand, nowadays…. ,[object Object]

Spinal Metastases ,[object Object],[object Object],[object Object],[object Object],[object Object]

Epidemiology ,[object Object],[object Object],[object Object],[object Object],[object Object]

Significance ,[object Object],[object Object],[object Object],[object Object],[object Object]

Future ,[object Object],[object Object],[object Object],[object Object]

Pathophysiology ,[object Object],[object Object],[object Object],[object Object],[object Object]

Primary Sites MD Anderson 1984-1994 (n=11,884) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Level of Metastases ,[object Object],[object Object],[object Object]

Clinical Presentation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Spine Surgeon’s Role ,[object Object],Schiff D, O’Neill BP, Suman VJ. Spinal epidural metastasis as the initial manifestation of malignancy: clinical features and diagnostic approach. Neurology 1997;49:452–456.

Evaluation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Radiological Evaluation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Radiological Evaluation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Biopsy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Lis E, Bilsky MH, Pisinski L, Boland P, Healey JH, O'malley B, Krol G. Percutaneous CT-guided biopsy of osseous lesion of the spine in patients with known or suspected malignancy. AJNR Am J Neuroradiol 2 004;25:1583-1588.

Goal of Management ,[object Object],Curative in certain solitary metastasis

To achieve the goal…. ,[object Object],[object Object],[object Object]

Treatment Options ,[object Object],[object Object],[object Object],[object Object],[object Object],Multi-disciplinary approach

Pitfall ,[object Object],[object Object]

Steroids ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Bisphosphonates ,[object Object],Pavlakis N, Schmidt RL, Stockler M: Bisphosphonates for breast cancer. Cochrane Database Syst Rev 2005, (3): CD003474. ,[object Object]

Radiotherapy ,[object Object],[object Object],[object Object],[object Object]

External Beam Radiotherapy (EBRT) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

External Beam Radiotherapy (EBRT) ,[object Object],[object Object],[object Object],[object Object],[object Object],Young RF, Post EM, King GA. Treatment of spinal epidural metastases. Randomized prospective comparison of laminectomy and radiotherapy. J Neurosurg 1980 Dec;53(6):741-8.

Laminectomy is a bad option ,[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object]

Patchell et al, The Lancet 2005

Patchell et al, The Lancet 2005 ,[object Object],[object Object]

Patchell et al, The Lancet 2005 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

External Beam Radiotherapy (EBRT) ,[object Object],[object Object],[object Object],[object Object],[object Object]

Radiotherapy Modalities ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Indications of Radiotherapy As Primary Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object]

Adjuvant Radiotherapy ,[object Object],[object Object],[object Object],[object Object]

Effects of radiation on spinal fusion ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Effects of Radiation on Spinal Fusion Bouchard et al, Spine 1994 ,[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],Decision Making (Prognostic Decision Rules)

Frankel 1969 ,[object Object],[object Object],[object Object],[object Object],[object Object]

Harrington K. Metastatic disease of the spine. J Bone Joint Surg Am. 1986 Sep;68(7):1110-5. ,[object Object],[object Object],[object Object],[object Object],[object Object],Non-operative Operative Radio

Tokuhashi et. al. 1990 ,[object Object],[object Object],[object Object],[object Object]

Karnofsky (Frankel’s) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Tomita et. al. 2001 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Predictive value of 7 preoperative prognostic scoring systems for spinal metastases Leithner et al, Eur Spine J 2008 ,[object Object],[object Object],[object Object]

Predictive value of 7 preoperative prognostic scoring systems for spinal metastases Leithner et al, Eur Spine J 2008

Indications for Surgery ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Spinal Instability ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Spinal Instability ,[object Object],[object Object],[object Object]

Spinal Instability Taneichi et. al., Spine 1997 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Principles of Surgical Treatment “Objectives” ,[object Object],[object Object],[object Object],[object Object],[object Object]

Boriani-Weinstein-Biagini Staging System Spine 1997

Surgical Options ,[object Object],[object Object],[object Object],[object Object]

Meta-analysis of Surgery versus Radiotherapy ,[object Object],[object Object],[object Object],[object Object],Klimo P Jr, Thompson CJ, Kestle JR, Schmidt MH. A meta-analysis of surgery versus conventional radiotherapy for the treatment of metastatic spinal epidural disease. Neuro Oncol. 2005 Jan;7(1):64-76.

[object Object],[object Object],Meta-analysis of Surgery versus Radiotherapy Klimo P Jr, Thompson CJ, Kestle JR, Schmidt MH. A meta-analysis of surgery versus conventional radiotherapy for the treatment of metastatic spinal epidural disease. Neuro Oncol. 2005 Jan;7(1):64-76.

MIS for Spinal Metastases ,[object Object],[object Object],[object Object]

Kyphoplasty for Metastases ,[object Object],[object Object],[object Object]

Bottom Line Tumor Treatment Patient ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Thank You Calgary Spine Tumor Day?

Spinal Metastases

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