Metastatic spinal lesions: state-of-the-art treatment options and future trends

Abstract

The purpose of this article is to review the current state of the art for treating symptomatic spinal fractures associated with malignant lesions and to present potential future trends in treatments for this patient population. Epidemiology, clinical presentation, and biomechanical ramifications of these lesions are summarized and treatment regimes, clinical outcomes, and complications and technical issues associated with treatments are presented. Potential future trends and new technologies for performing vertebral body augmentation in patients with metastatic spinal lesions are also discussed.

Fig 1.

The vertebral body can be depicted as a cube composed of 27 smaller cubes to indicate tumor location: oblique (A) and lateral (B) views. (Reprinted with permission from Elsevier Ltd.)

Fig 2.

Tumor infiltration or damage to portions of the cube depicted in Fig 1 may destabilize the spine in varying fashions. Destruction of the middle third in the axial plane (A) results in gross instability, whereas destruction of the middle third in the sagittal plane (B) may not be associated with significant destabilization. A lesion in the ventral portion of the vertebral body in the coronal plane (C) affects stability more than a lesion in the middle (D) or dorsal (E and F) portions. (Reprinted with permission from Elsevier Ltd.)

Fig 3.

The vertebral body and adjacent structures can be depicted as 4 disparate zones when considering surgery to treat vertebral body tumors.

Fig 4.

A, A 71-year-old woman with undifferentiated cancer and a lesion at L4. B and C, A void is created in the vertebral body by debulking the spinal tumor using the plasma radio-frequency–based wand before vertebral body augmentation with bone cement. D–F, Axial (D and E) and sagittal (F) views by using MR imaging show excellent anterior placement of bone cement.

Fig 5.

Candidates for percutaneous vertebral body augmentation who have spinal metastasis are best identified by evaluating the suggested treatment site by using CT and MR imaging (MRI). RFA indicates radio-frequency ablation.