Spinal Metastasis

What is Spinal Metastasis?

Spinal metastases are tumors that are most commonly found in the spine. These tumors account for approximately 90% of masses observed in spinal images or scans. Although they’re most often found as bone metastasis, bone metastasis isn’t the only type. Around 20% of these tumors show signs of invading the spinal canal and pressing on the spinal cord. These tumors are most commonly located in the mid-back or thoracic region, followed by the lower back or lumbar region. The neck or cervical region is the least likely place to find these tumors.

When these tumors are examined using MRI scans, an identifying feature is that the space between the vertebrae, known as the intervertebral disc space, is usually unharmed. This is contrary to infections where this disc space is typically affected. These metastatic diseases, or cancers that have spread from their initial location to the spine, can invade the spine through various pathways. These include the spreading through blood, whether via veins or arteries, direct extension from an existing tumor, or spread through the lymph system. Out of these routes, the most common is the spread through the blood, specifically the Batson’s plexus system – a network of veins within the spinal column. This route is often implicated in tumor migration and spinal invasion. Having a strong understanding of these aspects is crucial when treating patients with spinal metastasis.

What Causes Spinal Metastasis?

Spine cancer is often a result of other cancers spreading, or metastasizing, to the spinal column. The most common cancers that spread to the spine come from the breast (21% of cases), lung (19%), prostate (7.5%), kidney (5%), gastrointestinal tract (4.5%), and thyroid (2.5%). These cancers typically spread to the spine early on in the disease.

Research is ongoing to understand exactly how and why these tumors invade the spine. However, some factors have been identified that seem to play a role. A key factor is the interaction of two proteins, RANK and RANKL (which are short for receptor activator of nuclear factor kappa beta ligand). These proteins interact with receptors to trigger activity in cells called osteoclasts, which can contribute to the spread of cancer in the spine.

Risk Factors and Frequency for Spinal Metastasis

Spinal metastasis, which is the spread of cancer to the spine, is commonly seen in cancer patients. In a study that examined deceased patients who had known cancer, nearly 70% to 90% of the people with breast or prostate cancer had spinal metastasis. This condition can cause severe back pain, which often requires strong pain medication. It can also lead to fragile bones that break easily, an excess of calcium in the blood, and pressure on the spinal cord due to the growth of tumor in the area around the spinal cord.

Occasionally, the spinal metastasis may not affect the bones, but instead grow inside the spinal cord itself. In such cases, especially when there is no known prior history of cancer, diagnosing that the spinal lesions come from cancer can be difficult. Often, the correct diagnosis is only made when a pathologist confirms the type of tumor.

Spinal metastasis is common in cancer patients.
A study showed 70% to 90% of deceased breast or prostate cancer patients had spinal metastasis.
This condition can cause severe back pain that requires strong pain medication.
It can also lead to fragile bones that break easily, an excess of calcium in the blood, and pressure on the spinal cord.
Sometimes, the cancer grows inside the spinal cord and doesn’t affect the bones.
In such cases, when there’s no known history of cancer, diagnosing the spinal lesions as cancer can be challenging.
Often, the correct diagnosis is only confirmed by a pathologist who identifies the type of tumor.

Signs and Symptoms of Spinal Metastasis

Spinal metastasis, which is a type of cancer that spreads to the spine, often first presents as pain. This is especially true in individuals who already have a cancer diagnosis, and it’s crucial for doctors to be vigilant when these patients report neck or back pain. Though this pain may not be the most severe symptom of spinal metastasis, it’s usually the first one that prompts medical attention.

The pain experienced is often deep and aching, frequently waking the patient from their sleep at night. Sometimes, if the pain becomes sharp and shooting, it might suggest that the tumor has spread and is now affecting nerves. This type of pain usually follows a specific skin pathway. In some cases, if the tumor makes its way into the spinal canal, the patients may begin to experience lasting weakness or sensory issues which are of greater concern.

The extent of the weakness and the progression of the disorder, especially the speed at which the illness is identified and treated by a healthcare professional, are all crucial factors. In general, the worse a patient’s condition is when they first seek treatment, the lower their chances are of a full recovery.

Testing for Spinal Metastasis

When a patient who has cancer experiences neck or back pain, one of the simplest tests a doctor can use to examine them is an x-ray of the spine. However, this technique often isn’t very effective at detecting specific problems unless there’s been considerable bone damage.

Instead, for a more accurate investigation of these conditions, the preferred method is a type of scan called a spinal magnetic resonance imaging (MRI). This scan can show the extent of the condition, which parts of the spine are involved, whether the spinal canal is affected, and can provide clues about the origin of the spread of cancer (known as metastasis).

However, not all patients can have an MRI scan, such as patients who have a pacemaker or an internal defibrillator. In these instances, another type of procedure called a myelography, possibly in combination with a computed tomography (CT) scan, may be considered. A myelography involves injecting a special dye into the spinal cord and then taking x-rays or CT scans. It allows the doctor to see the cerebrospinal fluid (the fluid within the spinal canal) in greater detail and can even provide a sample for further testing. A drawback of this procedure is that it might be less effective when a lesion fully blocks the canal, and it might require several injections of the dye to get around the blockage.

Additionally, a Positron Emission Tomography (PET) scan can be used. This scanning method uses a small amount of radioactive tracer to highlight areas of concern in the body. While it’s sensitive at detecting lesions, a potential drawback is that it doesn’t provide a detailed localization of the lesions within the body.

Treatment Options for Spinal Metastasis

When cancer has spread to multiple bones and there’s no risk of fractures or damage to the spinal canal, the individual can typically manage the condition without surgery. Nevertheless, a specialist in spine cancer surgery should give advice, as associated spine stability could be at risk due to the multiple spread of cancer to the spine.

In some situations, where the individual shows normal neurological exams despite having multiple cancer spread to the spine, radiation therapy and chemotherapy may be mainly beneficial. If we need to identify the type of cancer and a sample tissue is required, and there’s no primary or easily obtainable spread of cancer through any other route, the patient may gain from a picture-guided biopsy of the bone lesion – a procedure where a sample of bone tissue is collected using imaging guidance. Open biopsies, which are performed in an operating room, are very rarely necessary after several unsuccessful needle biopsies.

However, the treatment strategy changes significantly when the spine’s central passage becomes involved with a tumor. Immediate consultation with a surgeon is needed, as these patients can become bed-bound within a few days. Studies have found that paralysis (the inability to move parts of the body) due to cancer spread to the spine can dramatically reduce patient’s lifespan. Surgical intervention performed to patients with sudden paralysis caused by the cancer’s pressure on the spinal cord can significantly lower the rate of mortality and illness related to sudden paralysis.

Depending on the speed and severity of the neurological problems, doctors may add steroids to the treatment. Dexamethasone, a steroid medication, has been shown to reduce pain and improve symptoms. But the ideal dosage is yet unclear. Immediate imaging tests should be performed to assess the extension of the disease and the possibility of surgical intervention.

If doctors suspect a tumor that is less likely to respond to radiation therapy, if there’s complete paralysis lasting more than 24 hours, or if the patient’s expected survival is less than a few months, they often consider surgical intervention necessary. Following surgery, further treatments usually involve a team of experts providing chemotherapy and focused radiation. The wound closure after radiation and chemotherapy becomes a concern and the patient should be closely monitored for wound complications.

Currently, the treatment plan for spine cancer spread is based on the NOMS (Neurologic, Oncologic, Mechanical, Systemic) framework. This strategy includes assessing the severity of spinal cord compression and neurological status, radiosensitivity of the primary tumor, the stability of the spinal column and the patient’s overall health condition, including their ability to withstand surgery. Based on these factors, doctors determine a suitable treatment plan, which can include radiation therapy alone or with stabilization surgery, or a surgical procedure to remove the tumor and stabilize the spine.

When doctors try to identify the cause of spinal metastases, or cancer that has spread to the spine, they consider several other possible conditions. These include:

Primary spinal tumors, like myeloma, plasmacytoma, lymphoma, and sarcoma
Spinal infections – Pyogenic (caused by bacteria) and granulomatous (causing inflammation) including tuberculosis

What to expect with Spinal Metastasis

The outlook for spinal metastasis, a condition where cancer has spread to the spine, depends on several factors. These include the patient’s overall health, the type of the primary cancer, whether the cancer has spread to other organs or bones, and the patient’s neurological condition or the state of their nervous system.

Possible Complications When Diagnosed with Spinal Metastasis

The main complications linked to spinal metastasis include:

The pathological breaking and collapsing of bones
Injuries to the spinal cord or other nerves
Bleeding
Resistance to treatment options
Reoccurrence or return of the tumor
Infections due to a weakened immune system

Preventing Spinal Metastasis

1. Patients need to be alert to the risk that the affected part of their spine, or vertebrae, might collapse in a way that’s not normal. Because of this, doctors sometimes suggest using braces or other devices to keep the spine from moving as a way of avoiding this collapse. This is separate from when doctors stabilize the spine through surgery. Patients need to follow their doctor’s advice closely in these situations. It’s really crucial.

2. How well a patient recovers their nerve function often depends on how long and how severe the loss of function is. This means that if a patient has nerve function issues, it’s really crucial that they see a specialist in spine surgery as soon as possible. The urgency in getting specialized help cannot be stressed enough.

Frequently asked questions

The prognosis for spinal metastasis depends on several factors, including the patient's overall health, the type of primary cancer, whether the cancer has spread to other organs or bones, and the patient's neurological condition or the state of their nervous system.

Spinal metastasis is often a result of other cancers spreading, or metastasizing, to the spinal column. The most common cancers that spread to the spine come from the breast, lung, prostate, kidney, gastrointestinal tract, and thyroid. These cancers typically spread to the spine early on in the disease.

Signs and symptoms of Spinal Metastasis include: - Pain, which is often the first and most common symptom. It can be deep, aching, and may wake the patient from sleep at night. - Sharp and shooting pain, which may suggest that the tumor has spread and is affecting nerves. This type of pain usually follows a specific skin pathway. - Weakness or sensory issues, especially if the tumor has made its way into the spinal canal. This can lead to lasting weakness or sensory problems. - The extent of weakness and the progression of the disorder are crucial factors. The speed at which the illness is identified and treated by a healthcare professional is also important. - Patients who already have a cancer diagnosis should be vigilant when reporting neck or back pain, as it could be a sign of spinal metastasis. - The severity of the symptoms can vary, and prompt medical attention is important to improve the chances of a full recovery.

The types of tests needed for spinal metastasis include: 1. X-ray of the spine: This is a simple test that can be used to examine the spine, but it may not be very effective at detecting specific problems unless there has been considerable bone damage. 2. Spinal magnetic resonance imaging (MRI): This is the preferred method for a more accurate investigation of spinal metastasis. It can show the extent of the condition, which parts of the spine are involved, whether the spinal canal is affected, and can provide clues about the origin of the spread of cancer. 3. Myelography with computed tomography (CT) scan: This procedure involves injecting a special dye into the spinal cord and then taking x-rays or CT scans. It allows the doctor to see the cerebrospinal fluid in greater detail and can provide a sample for further testing. It may be considered for patients who cannot have an MRI scan. 4. Positron Emission Tomography (PET) scan: This scanning method uses a small amount of radioactive tracer to highlight areas of concern in the body. It is sensitive at detecting lesions but does not provide a detailed localization of the lesions within the body. 5. Picture-guided biopsy of the bone lesion: If a sample tissue is required to identify the type of cancer and there is no primary or easily obtainable spread of cancer through any other route, a picture-guided biopsy of the bone lesion may be performed. This procedure involves collecting a sample of bone tissue using imaging guidance. 6. Immediate imaging tests: Immediate imaging tests should be performed to assess the extension of the disease and the possibility of surgical intervention.

The other conditions that a doctor needs to rule out when diagnosing Spinal Metastasis are: - Primary spinal tumors like myeloma, plasmacytoma, lymphoma, and sarcoma - Spinal infections, including pyogenic (caused by bacteria) and granulomatous (causing inflammation) infections such as tuberculosis.

The side effects when treating Spinal Metastasis include: - The pathological breaking and collapsing of bones - Injuries to the spinal cord or other nerves - Bleeding - Resistance to treatment options - Reoccurrence or return of the tumor - Infections due to a weakened immune system

A specialist in spine cancer surgery.

Spinal metastasis is common in cancer patients.

Spinal metastasis can be treated in various ways depending on the specific situation. If the cancer has spread to multiple bones but there is no risk of fractures or damage to the spinal canal, surgery may not be necessary. In these cases, a specialist in spine cancer surgery should be consulted to assess the stability of the spine. Radiation therapy and chemotherapy may be beneficial for individuals who show normal neurological exams despite having multiple cancer spread to the spine. If a tissue sample is needed to identify the type of cancer and there is no primary or easily obtainable spread of cancer through any other route, a picture-guided biopsy of the bone lesion may be performed. However, if the spine's central passage becomes involved with a tumor, immediate consultation with a surgeon is necessary as paralysis can occur rapidly. Surgical intervention in these cases can significantly lower the rate of mortality and illness related to sudden paralysis. The treatment plan for spinal metastasis is based on various factors including spinal cord compression, neurological status, primary tumor radiosensitivity, spinal column stability, and overall health condition. Treatment options can include radiation therapy alone or with stabilization surgery, or surgical removal of the tumor and spine stabilization.

Spinal metastasis refers to tumors that are commonly found in the spine, accounting for approximately 90% of masses observed in spinal images or scans. These tumors can invade the spinal canal and press on the spinal cord, with the most common locations being the mid-back or thoracic region, followed by the lower back or lumbar region. The neck or cervical region is the least likely place to find these tumors.

Bony Metastases Cancer Metastatic Disease Spinal Cord Compression Spine