Table 6 The surgical options to be considered in spinal metastasis
Presentation | Intervention | Aims and comments |
|---|---|---|
Metastasis from highly vascularized primary tumour | Preoperative embolisation of metastasis | - Reduce blood loss in surgery |
| Â | Â | - More precise and extensive tumour resection |
Dorsal thoracic or lumbar metastasis | Dorsal spine decompression | - Pain relief, neurological improvement |
| Â | Â | - Reduce tumour volume |
| Â | Â | - Resect structures bordering spinal canal dorsally (laminectomy and hemi-facetectomy) |
| Â | Â | - Prevent spinal cord transection |
| Â | Â | - Spine stabilisation |
Cervical metastasis | Ventral decompression with coroporectomy, vertebral body replacement, and ventral stable-angle plate osteosynthesis | - As for thoracic and lumbar metastasis |
Solitary spinal metastasis | Ventral tumour resection | - Removal of malignancy |
| Â | Â | - Prognosis good |
Vertebral metastasis without neurologically compromise | Vertebroplasty/kyphoplasty | - Stabilisation |
| Â | Â | - Pain relief |
| Â | Â | - Prevent destruction of vertebral body |
| Â | Â | - Possible benefit to neurological function |