Injury to the spine due to metastatic cancer

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Injury to the spine due to metastatic cancer is a common complication in cancer patients, which can cause pain and loss of nerve function. Most tumors metastasize to the vertebral body and grow outside the spinal cord. Early detection of bone metastases and early treatment aim to restore nerve function, treat pain, and prevent future neurological complications.

1. Metastatic spinal tumor

1.1. What is metastatic cancer of the spine? Bone metastases occur when cancer cells metastasize from the original site of disease to the bone. Cancer that has metastasized to the bone can occur in any bone but most commonly occurs in the spine, pelvis, and femur. When a tumor spreads to the spine due to cancer elsewhere in the body, it is called spinal metastases (secondary tumor).
Most metastatic spinal tumors are found in the vertebrae. Rarely, they can develop in the spinal cord or dura. Not all metastatic spinal tumors have symptoms, but if they do, the first symptom is usually back pain.
The most common parts of the body for cancer cells to metastasize include the kidneys, lungs, and bones. When cancer metastasizes to bone, it usually spreads to one or more vertebrae due to the extensive venous network of the spine.
Cancer cells usually reach the spine through the bloodstream, then they enter the bone marrow and begin to multiply. Tumors in the vertebrae can weaken the bone, eventually causing the bone to break. Fractures can cause severe pain, damage the spine, and seriously affect a patient's quality of life.
1.2. Progression of metastatic spinal tumors People over the age of 50, or with a history of cancer, are more likely to develop a metastatic spinal tumor. An untreated metastatic spinal tumor can continue to grow and can be life-threatening.
Treatment for metastatic spinal tumors depends on many factors, including the general health and life expectancy of the patient. Prognosis is better when treatments can preserve neurological function, such as the ability to walk.
Treatment options for metastatic spinal tumors may include radiation therapy, chemotherapy, immunotherapy, and surgery. In cases of advanced cancer or when the patient is not able to tolerate surgery well, palliative care is often recommended. Palliative care focuses on reducing pain and living comfortably rather than curing or removing the tumor.
1.3. Where can metastatic spinal cancer occur Spinal tumors can occur anywhere along the spine, but most occur in the intrathoracic region:
About 70% of tumors metastatic spinal tumor occurring in the thoracic region; About 20% occur in the lumbar region (lower back); Rarely occurs in the neck region. There are also cases of spinal cancer that has spread to more than one area of ​​the spine at the same time. Approximately 90% of spinal tumors are diagnosed as metastatic spinal tumors.

2. Symptoms of metastatic spinal tumor

Symptoms and signs of metastatic spinal tumors often include back or neck pain, depending on where inside the spine. Nerve impairment, such as weakness, tingling, or numbness in the hands or feet may also develop. Effects on nerve function tend to occur weeks or months after the onset of back pain.
2.1. Pain from metastatic spinal cancer Back pain caused by spinal tumors tends to be severe and does not improve with rest. There are different types of pain that can be caused by a metastatic spinal tumor.
Soreness in bones Tumor growth can lead to a number of biological reactions, such as local inflammation or stretching of the anatomical structures around the vertebrae. These biological pains are often described as a deep pain that tends to be worse at night, even to the point of disrupting sleep. The pain may also be worse upon waking in the morning and improve somewhat after getting up and walking.
Pain that radiates down the arm or leg Pain that travels along a nerve path - such as from the thoracic vertebra into the chest or from the lumbar vertebra down the leg. This pain often causes a burning or shock-like sensation to the extremities.
Pain when moving If the tumor grows inside the vertebrae, the walls of the vertebrae may become thin and weak. If left untreated, the bone can break. Vertebral fractures can lead to pain that has a sudden onset and tends to be more intense with movement or when pressure is placed on the bone, such as when sitting or standing.
2.2. Nerve dysfunction Radiculopathy When spinal nerve roots are compressed, radiculopathy can occur with tingling, numbness, and weakness spreading to the chest, abdomen, legs, or wings. hand. For example, a metastatic spinal tumor in the lumbar spine can compress a nerve root and cause pain and weakness in the leg. Radiculopathy is usually unilateral, but can also be bilateral if nerve roots are compressed on both sides of the spine.
Myelopathy When the spinal cord is compressed, spinal cord disease can occur. Neurologic deficits can develop anywhere below the degree of spinal cord compression. For example, compression of the spinal cord in the neck can cause tingling, numbness, and weakness in the arms or legs.
Cauda Equina Syndrome This syndrome usually occurs when the nerve roots of the cauda equina are compressed. Patients may experience disruption of motor and sensory functions to the lower extremities and bladder. Patients with this cauda equina syndrome are often hospitalized in an emergency and may require quick surgery.

3. Diagnosis of metastatic spine cancer

Diagnosis of metastatic spinal tumors is a multi-step process that includes a thorough medical history, physical examination of organs, and then a general physical examination. Tests commonly performed to diagnose metastatic spine cancer include:
Magnetic resonance imaging (MRI): Magnetic resonance imaging of the entire spine (neck, thoracic, and lumbar) with and without injections. magnetic contrast. Magnetic resonance imaging should be performed as soon as possible (within 24 hours of suspected spinal cord compression). Computed tomography of the spine (CT): in case there are contraindications to magnetic resonance imaging (patients carrying metal foreign bodies, pacemakers...). Abdominal ultrasound, neck ultrasound, otolaryngoscopy, gastroscopy, mammogram, colposcopy, computed tomography of the brain....depending on the diagnostic orientation to find the tumor spine and assess for spread. Combination of conventional X-ray and bone scan: to identify vertebral lesions but not spinal cord lesions. Bone scintigraphy: to accurately detect the location and number of metastatic bone lesions. PET/CT scan: helps to detect the primary lesion, the extent of invasion, the status of metastasis. Other tests: blood count, liver and kidney function, coagulation, electrolytes, HbsAg, HIV...

4. Treatment of metastatic spinal tumors

4.1. Treatment Goals for Metastatic Spinal Tumors Most metastatic spinal tumors develop within a vertebra and weaken the bone over time. If a vertebra is broken, the spine will be unstable, which can lead to more pain and possibly compression of the spinal cord or spinal nerves. Given these common complications, treatment goals for metastatic spinal tumors tend to include:
Pain relief: Since metastatic spinal tumors are the result of cancer spreading, the primary goals of treatment is to relieve pain and maintain the patient's quality of life. Preserving nerve function: It may be necessary to maintain or restore spinal stability to preserve nerve function, such as walking and controlling bowel and bladder function. People with metastatic spinal tumors tend to have a better prognosis when they are able to maintain the ability to walk. Support existing cancer treatments: Primary cancer treatments are often designed to prolong life and provide optimal patient comfort. Shrink or remove the tumor: When possible, the doctor will appoint surgery to destroy or shrink the spinal tumor thereby reducing the burden on the patient's body. In general, early diagnosis and treatment of metastatic spinal tumors will yield better outcomes. Cancer patients who have back pain and neurological signs, such as numbness or weakness in the limbs, should seek immediate medical attention.
4.2. Surgical treatment Surgery to remove the entire vertebral body with metastatic tumor, spinal screw splint
Indications:
Metastatic tumor in the spine that compresses the spinal cord, causing spinal instability Patients who still have compression compression after radiotherapy The patient needs surgery to stabilize the spine and take histopathology for pathology. Pumping cement (cement) to shape the vertebrae.
Indications:
Patients with pain due to metastatic tumor causing vertebral collapse and no evidence of spinal cord compression. In patients treated for metastatic tumors of the spine: persistent spinal pain due to vertebral collapse due to osteoporosis. Persistent spinal pain in a patient with vertebral collapse who received radiotherapy to the area of ​​spinal metastases. Purpose: Strengthening the spine, treating symptoms of pain caused by vertebral collapse to help improve the quality of treatment. It should be noted in combination with other treatment methods: Radiotherapy and chemotherapy.
Methods that can be used: Cement pump with balloon, cement pump without balloon, treatment of spinal metastases with radiofrequency waves and cement injection into the vertebral body.
4.3. Radiation therapy Radiation therapy is the first choice treatment for metastatic spinal tumors, especially for radiotherapy-sensitive tumors such as lymphoma, multiple myeloma.
Anti-compression radiation therapy in the case of patients with acute nerve compression inoperable.
4.4. Medical treatment Corticosteroid treatment Usually applied in the early stages of the disease to combat edema of the pulp, relieve pain by inhibiting the release of local inflammatory substances.
Application dose is usually high dose: 4-8 ampoules of dexamethasone 4mg/every 6 hours.
Chemotherapy Chemotherapy is often indicated for chemosensitive tumors such as lymphoma, multiple myeloma, neuroblastoma, germ cell tumor. However, the majority of spinal metastatic tumors with spinal cord compression are tumors that are less sensitive to chemotherapy, in addition to nerve compression, which needs to be treated early, so surgery or radiation therapy is often applied. used before chemotherapy.
Bisphosphonate: Use Pamidronate 90mg or zoledronic acid 4mg intravenously every 3-4 weeks.
4.5. Treatment in cases of metastatic cancer of the spine with compression syndrome Spinal cord compression is a common complication in cancer, painful consequences and irreversible loss of nerve functions. When there is a primary cause or a secondary injury to the spine that compresses the spinal cord, this syndrome will occur.
In adults, the last part of the spinal cord is at the level of the 1st lumbar vertebra, below this level is the lumbar plexus - which together form the cauda equine organization in the cerebrospinal fluid. If the vertebrae and spinal cord are injured on the 1st lumbar segment, the risk of spinal cord compression will be higher (thoracic vertebrae account for 60-70%, dorsal vertebrae 20-30%, rarer than the lumbar region about 10%). .
Treatment principles: Combining methods including medical treatment, radiation therapy, surgery to release nerve compression by opening the posterior arch of the vertebrae, improving pain symptoms and motor function to recover. neurological rehabilitation.

In summary, when the patient has metastatic bone cancer, the treatment methods only contribute to the relief of pain symptoms. In case patients want safe and effective rehabilitation treatment, they can contact the rehabilitation department of Vinmec International General Hospital to be assigned specific treatment by doctors for each case. . The Department of Rehabilitation is fully invested, with a complete and rich system of physical therapy equipment and machinery originating from the world's leading manufacturer of physical therapy equipment. like the Netherlands; Japan....
Spinal traction bed Neck spinal extension rig Large short wave machine Treatment ultrasound machine Pulsed electric machine Passive knee flexion and extension machine Programmable bicycle system Muscle exercise machine system, Joint training Strength training machine system and multi-function training bed system BoBab exercise bed system... The technicians are formally trained, at the university and college level, having worked in various departments. Rehabilitation of large hospitals. In addition, from time to time, the Faculty also has an increase of foreign technicians working together and exchanging experiences. The care support team is available to assist the patient in safe mobility.

Please dial HOTLINE for more information or register for an appointment HERE. Download MyVinmec app to make appointments faster and to manage your bookings easily.

Reference source: Spine-health.com