Abstract :
Spinal metastasis is a frequent occurrence in patients presenting with advanced malignancy. The burden of this condition is on rise, especially with the availability of aggressive treatment regimens for the primary disease and the improvement in the patient survival. Thoracic spine is the most affected region. The likely source of the primary is from the breast, prostate, lung, thyroid, or kidney. Certain hematological and other malignant conditions can also develop an early spinal involvement that requires timely evaluation and management. The goals for the management of the spinal lesion include preservation of the neurological function, pain control, and maintenance of spinal stability. On the whole, the aim of the treatment continues to palliation in majority of the scenarios. The management strategy is based on the factors that include the patient condition, life expectancy, nature of the tumor pathology, extent of spinal cord compression, severity of neurological deficit, pain control, and the effect on spinal stability. A multidisciplinary approach involving medical oncology, radiation oncology, spine surgery, palliative care and other subspecialtiess forms the cornerstone of the management. Although giant strides have been reported in the advancement of the treatment for spinal metastasis, majority of these avenues are beyond the reach of the patient population from the developing societies. Lack of referral facilities, resource constraints, and geographic disparities are major impediments. The lack of awareness and consensus on the management protocols within the treatment team and the medical community in general poses another challenge in providing an acceptable standard of care. This article offers an insight into the principles that guide the management of spinal metastasis. The application of these principles in the background of the resource constraints that are unique to the South Asian population has also been addressed. This is a synopsis on the multidisciplinary approach to the diagnosis and management of spinal metastasis along with the review of the relevant literature.
Keyword :
Vertebral metastasis, spinal stability, pathological fracture, spinal cord compression