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Surgical Management of Spinal Metastases
Paul Klimo, Jr., Meic H. Schmidt
Department of Neurosurgery, University of Utah School of
Medicine, Salt Lake City, Utah, USA. Correspondence: Meic H. Schmidt, M.D., University
of Utah, Department of Neurosurgery, 30 North 1900 East Suite #3B-409 SOM, Salt
Lake City, Utah 84132-2303, USA. Telephone: 801-581-6908; Fax 801-581-4385;
e-mail: meic.schmidt@hsc.utah.edu
Metastatic spread to the spinal column is a growing problem in
patients with cancer.
It can cause a number of sequelae including pain,
instability, and neurologic deficit.
If left untreated, progressive
myelopathy results in the loss of motor, sensory, and autonomic
functions.
Except in rare circumstances, treatment is palliative.
Traditionally, conventional fractionated external beam radiotherapy
has been the treatment of choice.
"Surgery" for metastatic
spinal disease was, and generally continues to be, equated with
laminectomy by many physicians.
However, there has been a remarkable
evolution in surgical techniques over the last 20 years.
Today, the
goal of surgery is to achieve circumferential decompression of the
neural elements while reconstructing and immediately stabilizing the
spinal column.
This has been made possible by the use of different
surgical approaches and the exploitation of a burgeoning array of
internal fixation devices.
More recently, minimally invasive surgical
techniques, such as endoscopy, kyphoplasty/vertebroplasty, and
stereotactic radiosurgery, have been added to the surgeon’s
armamentarium.
As the number of treatment options for metastatic
spinal disease grows, it has become clear that effective
implementation of treatment can only be achieved by a
multidisciplinary approach.
This will provide the surest means of
maximizing the quality of the remainder of the patient’s life.
Key Words: Spine· Metastases· Surgery· Radiosurgery·
Outcomes
© 2004 AlphaMed Press
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