Modern Techniques in the Treatment of Patients with Metastatic Spine Disease
| Autor: | Han Jo Kim, Peter S. Rose, Jacob M. Buchowski, Charbel D Moussallem |
|---|---|
| Rok vydání: | 2012 |
| Předmět: |
medicine.medical_specialty
Palliative care business.industry medicine.medical_treatment General Medicine Disease medicine.disease Spinal cord Spinal disease Surgery Radiation therapy medicine.anatomical_structure Quality of life Spinal cord compression Spinal decompression Medicine Orthopedics and Sports Medicine business |
| Zdroj: | Journal of Bone and Joint Surgery. 94:943-951 |
| ISSN: | 1535-1386 0021-9355 |
| DOI: | 10.2106/jbjs.l00192 |
| Popis: | The surgical management of metastatic disease of the spine continues to evolve. For most of the recent three decades, radiation therapy provided the mainstay of treatment for patients with symptomatic metastatic disease of the spine. Surgical treatment during this era often involved dorsal spinal cord decompression with no or limited spinal instrumentation1,2. These procedures generally provided only an indirect decompression of the spinal cord and often increased spinal instability. However, with advances in the understanding of metastatic processes in the spine and evolution of surgical techniques and instrumentation, surgical treatment plays a prominent role in the care of patients with metastatic epidural spinal cord compression. Studies have now yielded Level-I evidence on the efficacy of surgery for metastatic disease of the spine for improving quality of life and outcomes in patients with spinal metastasis. Concurrently, advances in radiation oncology now allow high-precision targeting of tumors and increased efficacy when treating radioresistant lesions3. These advances together have led to important advances in the treatment of metastatic disease of the spine. Research findings continue to identify appropriate candidates for surgical intervention for metastatic spinal disease as well as to define optimal surgical and radiation therapy techniques. In considering treatment methods, it is essential to account for factors such as tumor type and/or biology, extent of disease, neurologic status, an individual patient’s expectations, quality of life, and life expectancy. For example, hematopoietic tumors reliably respond to radiation therapy and rarely require surgery for a compressive neurologic deficit alone. Aggressive surgical intervention may be futile in the face of established neurologic deficit and/or rapidly advancing tumor refractory to treatments. However, many patients continue to present with symptomatic solid organ metastases and reasonable life expectancies and will benefit from a comprehensive evaluation by surgeons in concert with medical and … |
| Databáze: | OpenAIRE |
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