Metastatic Tumors Of The Spine - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes metastatic tumors of the spine.

Follow me on twitter:
https://twitter.com/#!/DrEbraheim_UTMC

View my profile on Linkedin:
  / nabilebraheim  

Osteoplastic lesion in an older male could be metastatic prostate cancer. Prostate-specific antigen (PSA) levels lower than 10-20 microgram per liter (ug/L) are rarely associated with bone metastasis. Biopsy of an osteoplastic lesion in the spine gives a low diagnostic yield. When you see an osteoplastic lesion of the spine, rule out Paget’s disease. Paget’s disease and metastatic prostate carcinoma can look the same. Wide spread metastasis with lung lesion and neurological deficits equal radiation therapy. This means do radiation therapy. Biosphonate in metastatic breast cancer leads to decrease in skeletal related events by 30-40%. Bisphosphonate prevents cancer treatment induced bone loss. Bisphosphonate corrects hypercalcemia and decreases metastatic bone pain in 50% of the patients. Life expectancy is from 6 months to 1 year and neurological deficit in lung cancer decompression and surgical stabilization. With pain, weakness, and lytic lesion on x-ray plus spine instability, you may want to do embolization before surgery to decrease the hemorrhage. Do corpectomy and stabilization. The most common location for skeletal metastasis from adenocarcinoma is the spine. Metastatic disease of the spine commonly originates in the vertebral body. Look at the pedicle. Look for the “winking owl sign”. Patient with thoracic pain, x-rays show a T9 lesion and a mass in the lung. Do metastatic work up. Check for spread of the lesion by bone scan. The spine is the most common site for skeletal metastasis. Approximately 40-80% of patients have spine metastasis. They primarily come from the breast, which can be diagnosed by a mammogram. Lung tumors can be diagnosed by a chest x-ray or CT scan of the chest. Prostate tumors can be diagnosed by the prostate-specific antigen (PSA) test. Kidney tumors can be diagnosed by CT scans of the abdomen. The kidney tumor is very vascular. Thyroid tumors can be diagnosed by an ultrasound. Breast and lung tumors metastasize more to the thoracic spine. In fact, the thoracic spine is the most common site of bony metastasize. The prostate tumor metastasizes more to the lumbar spine. In general, CT scan of the chest, abdomen, and pelvis locates the primary lesion in about 85% of cases. Lymphoma and multiple myeloma can also metastasize to the spine. Multiple myeloma can be diagnosed by serum protein electrophoresis (SPEP), urine protein electrophoresis (UPEP), and by skeletal survey. Multiple myeloma and thyroid tumors can be cold in bone scans. Metastasis may be connected to the batson venous plexus. The batson venous plexus is a valveless venous plexus of the spine that connects and provides a route for the spread of metastasis from organs to the axial structures including the spine. Pain is worse at night. Neurologic involvement including weakness and paralysis may occur. The pain can come from tumor invasion, fracture, instability, or compression of a nerve root or the spinal cord. The percentage of skeletal metastasis to a primary spine tumor is 40/1. It is rare to have a primary spine tumor. When you see a lesion of the spine, rule out spine metastasis. X-ray may miss small lesions. 30-50% of the trabecular bone must be destroyed for the lesion to be seen and bone scan may be negative in multiple myeloma. Osteoplastic lesions of the spine can be due to prostate or breast metastases. With MRI, the basic rule is that if the tumor involves the body of the vertebra and the pedicle, then it is probably a tumor. Infection usually involves the disc space. We should be certain of the diagnosis before we start treatment. To find the primary tumor you should do metastatic work up. Do CT scan of the chest, abdomen and pelvis. Do bone scan and do labs, such as serum protein electrophoresis (SPEP) and urine protein electrophoresis (UPEP), serum calcium, PSA, and sedimentation rate. If you find a primary tumor, the presence of a metastatic lesion can be confirmed by a needle or open biopsy. Biopsy of the most accessible lesion can be done in case of multifocal lesions. In general, you want to rule out benign tumors and infection. Biopsy may also be important if the spine lesion is the only lesion present in a patient with a known cancer history or if the clinical situations, the labs, and the imaging are uncertain. Treatment Is done to improve the patient’s quality of life, to decrease the pain, to protect, maintain and restore the neurological function, as well as achieve spine stability. How you approach the spine should be based on location of the compression and if instability is present or not.