Spinal Metastasis — Causes, Clinical Presentation, Investigations and Management
DNB Orthopaedics • May 2024 • Paper I • 10 Marks
Introduction
The spine is one of the commonest sites of skeletal metastasis. Metastatic deposits most often involve the vertebral body because of its rich red-marrow vascular supply and may subsequently extend into the posterior elements, epidural space and neural structures.
The major clinical problems are:
- Pain
- Mechanical instability
- Pathological vertebral collapse
- Neurological deficit due to metastatic epidural spinal cord compression
- Loss of mobility and quality of life
Metastatic spinal cord compression is an oncological emergency. New neurological deficit, sphincter disturbance or rapidly progressive pain requires urgent assessment.
A. Causes / Common Primary Tumours
Common cancers metastasizing to the spine include:
- Breast
- Prostate
- Lung
- Kidney / renal cell carcinoma
- Thyroid
- Gastrointestinal malignancies
- Melanoma
- Other solid-organ malignancies
Mnemonic: “BLT with a Kosher Pickle”
Breast • Lung • Thyroid • Kidney • Prostate
Routes of Spread
- Hematogenous spread — most important.
- Spread through the valveless vertebral venous plexus of Batson.
- Arterial dissemination through systemic circulation.
- Direct extension from adjacent structures — less common.
The posterior part of the vertebral body is frequently involved initially, with extension through the pedicle and cortex into…