ORTHOPEDIC MANAGEMENT OF SPINAL METASTASES

Spinal metastases result in severe spinal pain, neurologic deficits, o r both. These symptoms usually are caused by spinal instability, in wh ich conservative therapy can have no effect, and surgical treatment is required to restabilize the destroyed spinal segments. Surgical indic ations are instability of the spine, pain and/or paresis resistant to radiation therapy, acute progressing paresis, and unknown histologic d iagnosis. There are 2 surgical approaches for vertebral metastases: pr osthetic replacement and posterior stabilization. Single or 2 consecut ive diseased vertebrae should be treated with replacement surgery. In this series, excellent surgical outcome was attained with this procedu re, and surgical benefit was maintained until the terminal stage of ea ch patient. Multiple vertebral metastases are treated with posterior s tabilization using various instrumentation systems that provide rigid stabilization. To choose the most appropriate procedure for each patie nt, the local condition of the lesion and general status of the patien t, including prediction of life expectancy, should be evaluated fully. Spinal metastases develop early and are not terminal events. Therefor e, not only palliative treatment but also surgical intervention should be considered for spinal metastases when indicated.