Spinal metastases from renal cell carcinoma: Case note with an overview
Autor: | Ashok Shyam, Sahil Sanghavi, Parag Sancheti, Amogh Zawar, Ajay Kothari, Shailesh Hadgaonkar |
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Rok vydání: | 2021 |
Předmět: |
medicine.medical_specialty
Cord Decompression business.industry medicine.medical_treatment lcsh:Surgery lcsh:RD1-811 medicine.disease lcsh:RC346-429 030218 nuclear medicine & medical imaging Surgery 03 medical and health sciences 0302 clinical medicine Renal cell carcinoma medicine Case note Neurology (clinical) Embolization Spinal metastases business Grading (tumors) Pathological lcsh:Neurology. Diseases of the nervous system 030217 neurology & neurosurgery |
Zdroj: | Interdisciplinary Neurosurgery, Vol 23, Iss, Pp 100994-(2021) |
ISSN: | 2214-7519 |
Popis: | Background Metastases to spine from renal cell carcinoma is challenging to manage as they are chemo and radioresistant along with being rapidly expansile and extremely hyper vascular. Also, they continue to cause pain and may result in cord compression leading to subsequent neurodeficit. Total en-bloc resection remains the gold standard surgical intervention but is associated with increased morbidity. Hence, posterior decompression and fixation has been the current standard of surgical care. However, considering the risk of massive blood loss in renal cell carcinoma, pre-operative embolization within 48 h of surgery is recommended. Vertebroplasty has been described for stabilization of osteoporotic compression fractures as well as for metastatic vertebral body lesions. It offers both pain relief and anterior column support which may be lacking with posterior fixation. Case Description: The authors describe a 26-year-old paraplegic female with grade 4 renal cell carcinoma having metastatic deposits to dorsal spine with cord compression. She underwent pre-operative embolization 36 h prior to surgical intervention, which included vertebroplasty, decompression and posterior fixation with screws/rod. Conclusion Preoperative embolization decreases the risk of intraoperative haemorrhage in hyper vascular spinal metastases such as renal cell carcinoma. Vertebroplasty as an adjuvant to posterior surgical stabilisation is becoming a standard of care for palliative pain control associated with pathological vertebral compression fractures as it also provides an anterior column support helping in early ambulation. Also, Fuhrman’s grading can be relied upon as an independent prognostic factor. |
Databáze: | OpenAIRE |
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