Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Spinal Metastasis Follow-up

  • Author: Victor Tse, MD, PhD; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
 
Updated: Mar 31, 2014
 

Complications

See the list below:

  • Leptomeningeal metastatic disease: Metastatic disease to the neuraxis other than the brain parenchyma and the spinal column is uncommon. The metastatic tumors are occasionally found to have deposited onto the meninges and the cranial nerves (CNs). This accounts for less than 5% of metastasis tumors. Spread to the pituitary gland has been documented, but it accounts for less than 0.5% of cases of metastatic disease in the neuraxis.
  • Metastatic plexopathy is documented in the literature. Lung carcinoma, breast carcinoma, and non-Hodgkin lymphoma can metastasize to the brachial plexus.
    • In most of these cases, the tumors spread from the surrounding axillary lymph nodes to the neuronal structures.
    • Clinical features are pain in the upper shoulder girdle and the medial aspect of the forearm.
    • The lower plexus is most commonly involved; this involvement may be associated with Horner syndrome.
    • Direct infiltration is by far the most common cause of neoplastic plexopathy. The other common presentation is Pancoast tumor, in which tumor invades the nerve roots as they exit the paravertebral space close to the apex of the lung.
    • Peripheral neuropathy secondary to metastatic disease is unusual; it most probably is related to paraneoplastic syndromes. Isolated cranial neuropathy is uncommon. In most cases, such neuropathies are associated with carcinomatous meningitis.
  • Carcinomatous meningitis is found in 8% of autopsies in patients with systemic carcinoma. The most common cancers involved in carcinomatous meningitis are those of the breast, lung, and GI, followed by melanoma, non-Hodgkin lymphoma, and leukemia.
    • About 48% of cancers manifest as carcinomatous meningitis.
    • On clinical evaluation, carcinomatous meningitis affects several levels of the neuraxis. It has a predilection for the CNs, particularly affecting CNs VII, III, V, and VI.
    • The most common symptoms are headache, mental status changes, seizures, ataxia, nonobstructive hydrocephalus, and painful radiculopathy.
    • The workup, including MRI, usually but not always demonstrates meningeal enhancement at the basal cisterns. The ventricular lining is often involved. CSF analysis requires 10 mL of CSF. The yield of abnormal cells is 45%, rising to 85% with repeat lumbar puncture. The glucose level is low, with a high protein level. Carcinoembryonic antigen is reported with meningeal spread of lung (89%) or breast (67%) carcinomas.
    • If untreated, the median survival is less than 2 months. With radiotherapy and chemotherapy, the median survival is 5-8 months.
    • Chemotherapy is primarily given intrathecally, usually delivered by using an Ommaya reservoir. A commonly used drug is methotrexate 12 mg twice weekly with oral leucovorin rescue therapy and cytarabine and thiotepa, 50 mg and 10 mg twice weekly. Monoclonal antibodies, lymphokine-activated killer cells, and oral etoposide were recently tried.
Next

Prognosis

See the list below:

  • The outcome of metastatic disease to the spine and associated structures is uniformly bleak.[7]
  • The ultimate goals are to maintain the patient's independence and dignity and to optimize his or her comfort level.
  • Surgical intervention with extensive reconstruction should be performed only after thorough evaluation of the extent of the systemic disease and only with a clear understanding of the realistic expectation of the patients and their caretakers.
Previous
Next

Patient Education

For excellent patient education resources, visit eMedicineHealth's Cancer Center. Also, see eMedicineHealth's patient education article Brain Cancer.

Previous
 
Contributor Information and Disclosures
Author

Victor Tse, MD, PhD Associate Professor, Department of Neurosurgery, Stanford University Medical Center; Neurosurgeon, Kaiser Neuroscience

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Jorge C Kattah, MD Head, Associate Program Director, Professor, Department of Neurology, University of Illinois College of Medicine at Peoria

Jorge C Kattah, MD is a member of the following medical societies: American Academy of Neurology, American Neurological Association, New York Academy of Sciences

Disclosure: Nothing to disclose.

Chief Editor

Stephen A Berman, MD, PhD, MBA Professor of Neurology, University of Central Florida College of Medicine

Stephen A Berman, MD, PhD, MBA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, Phi Beta Kappa

Disclosure: Nothing to disclose.

References
  1. Khan L, Mitera G, Probyn L, Ford M, Christakis M, Finkelstein J, et al. Inter-rater reliability between musculoskeletal radiologists and orthopedic surgeons on computed tomography imaging features of spinal metastases. Curr Oncol. 2011 Dec. 18(6):e282-7. [Medline]. [Full Text].

  2. Wibmer C, Leithner A, Hofmann G, Clar H, Kapitan M, Berghold A, et al. Survival analysis of 254 patients after manifestation of spinal metastases: evaluation of seven preoperative scoring systems. Spine (Phila Pa 1976). 2011 Nov 1. 36(23):1977-86. [Medline].

  3. Dwright et al. Dwright et al. Journal of Neurosurgery Spine. 2012. 17:11-8.

  4. Fisher CG, DiPaola CP, Ryken TC, Bilsky MH, Shaffrey CI, Berven SH, et al. A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group. Spine (Phila Pa 1976). 2010 Oct 15. 35(22):E1221-9. [Medline].

  5. Patil CG, Lad SP, Santarelli J, Boakye M. National inpatient complications and outcomes after surgery for spinal metastasis from 1993-2002. Cancer. 2007 Aug 1. 110(3):625-30. [Medline].

  6. Ibrahim A, Crockard A, Antonietti P, Boriani S, Bünger C, Gasbarrini A, et al. Does spinal surgery improve the quality of life for those with extradural (spinal) osseous metastases? An international multicenter prospective observational study of 223 patients. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2007. J Neurosurg Spine. 2008 Mar. 8(3):271-8. [Medline].

  7. Wilson DA, Fusco DJ, Uschold TD, Spetzler RF, Chang SW. Survival and Functional Outcome After Surgical Resection of Intramedullary Spinal Cord Metastases. World Neurosurg. 2011 Nov 7. [Medline].

  8. Ahmed KA, Stauder MC, Miller RC, Bauer HJ, Rose PS, Olivier KR, et al. Stereotactic Body Radiation Therapy in Spinal Metastases. Int J Radiat Oncol Biol Phys. 2012 Feb 11. [Medline].

  9. Boehling NS, Grosshans DR, Allen PK, McAleer MF, Burton AW, Azeem S, et al. Vertebral compression fracture risk after stereotactic body radiotherapy for spinal metastases. J Neurosurg Spine. 2012 Jan 6. [Medline].

  10. Wang XS, Rhines LD, Shiu AS, Yang JN, Selek U, Gning I, et al. Stereotactic body radiation therapy for management of spinal metastases in patients without spinal cord compression: a phase 1-2 trial. Lancet Oncol. 2012 Jan 26. [Medline].

  11. Weitao Y, Qiqing C, Songtao G, Jiaqiang W. Open vertebroplasty in the treatment of spinal metastatic disease. Clin Neurol Neurosurg. 2011 Nov 14. [Medline].

Previous
Next
 
Spinal metastasis.
Spinal metastasis.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.