Tumor
Palliative Radiotherapy for Bone Metastases: an ASTRO Evidence-Based Guideline.
Lutz S, Berk L, Chang E, et al.
Int J Radiat Oncol Biol Phys. 2011; 79: 965-976.
PMID: 21277118
These society guidelines based on a systematic literature review specify eight recommendations on the use of radiotherapy, the mainstay treatment for spinal metastases. The paper also briefly discusses the role of surgery, but more importantly, this authoritative guide to radiotherapy enables surgeons to better coordinate multidisciplinary treatment with oncology colleagues.
web: http://download.journals.elsevierhealth.com/pdfs/journals/0360-3016/PIIS0360301610035777.pdf
Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial.
Patchell RA, Tibbs PA, Regine WF, et al.
Lancet. 2005; 366: 643-648.
PMID: 16112300
This multicenter randomized study compared surgery followed by radiotherapy versus radiotherapy alone for spinal metastases. Pain, ambulation, and neurological function improved so much more with surgery that the study was stopped early. This is the key study that began reinstating surgery as first-line treatment for spinal metastasis.
web: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)66954-1/abstract
Diagnosis and management of patients at risk of or with metastatic spinal cord compression: summary of NICE guidance.
White BD, Stirling AJ, Paterson E, Asquith-Coe K, Melder A; Guideline Development Group.
BMJ. 2008; 337: a2538.
PMID: 19039017
This treatment guidelines from NICE summarize their recommendations on the management of metastatic spinal cord compression. It addresses diagnosis, initial care, paralysis prevention, pain management, surgery, radiotherapy, and home care including rehabilitation. This is the most concise and authoritative guidelines on the management of metastatic spinal cord compression.
Does spinal surgery improve the quality of life for those with extradural (spinal) osseous metastases? An international multicenter prospective observational study of 223 patients.
Ibrahim A, Crockard A, Antonietti P, et al.
J Neurosurg Spine. 2008; 8: 271-278.
PMID: 18312079
This prospective multicenter study compared en bloc excision or debulking versus palliative decompression. Pain reduction occurred in 72% vs. 61%; mobility improved in 72% vs. 45%; and patients regained control of continence in 55% vs. 21%. This study provides support for more extensive surgery for spinal metastasis.
Safety and efficacy of percutaneous vertebroplasty in malignancy: a systematic review.
Chew C, Craig L, Edwards R, Moss J, O’Dwyer PJ.
Clin Radiol. 2011; 66: 63-72.
PMID: 21147301
This systematic review evaluated vertebroplasty for treatment of spinal tumors. Mean pain reduction was substantial in most studies reviewed. The rate of serious complications was about 5%, with death attributable to vertebroplasty in 5 of 987 patients (0.5%). This is a good overview of evidence on vertebroplasty for spinal malignancy.
web: http://download.journals.elsevierhealth.com/pdfs/journals/0009-9260/PIIS0009926010003624.pdf
Spinal Cord Compression in Patients with Advanced Metastatic Cancer: “All I Care About is Walking and Living My Life”.
Abrahm JL, Banffy MB, Harris MB.
JAMA. 2008; 299: 937-946.
PMID: 18314436
This paper uses a case history to present a literature review and elucidate clinical care for metastatic cord compression. It discusses the role of surgery within the wider treatment process and also uses extensive quotes to provide engrossing patient-centered perspectives. This paper brings this complex multidisciplinary clinical scenario to life.
Diagnosis and management of metastatic spine disease.
Sciubba DM, Petteys RJ, Dekutoski MB, et al.
J Neurosurg Spine. 2010; 13: 94-108.
PMID: 20594024
This narrative review provides a broad introduction to management of metastases. The topics include tumor characteristics, symptoms, diagnostic work-up, surgical treatment, adjuvant therapy, radiation therapy, and intramedullary metastases. A treatment decision flowchart is also included. This is a good overview of current management practices.
An Analysis of Decision Making and Treatment in Thoracolumbar Metastases.
Polly DW Jr, Chou D, Sembrano JN, Ledonio CG, Tomita K.
Spine. 2009; 34: S118-S127.
PMID: 19829271
This systematic review attempted to determine the best approach for surgical treatment of thoracolumbar metastases. The evidence was mostly weak due to heterogeneity of both metastasis descriptions and procedures. Ultimately, they recommend a posterior approach for T2-T5 but lack consensus for T6-L5. This is a good discussion of surgical approach.
Vertebral Tumors: Surgical versus Nonsurgical Treatment.
Simmons ED, Zheng Y.
Clin Orthop Relat Res. 2006; 443: 233-247.
PMID: 16462447
This narrative review presents information on primary and metastatic tumors. Individual features are described for six varieties of benign primary tumors. Nonsurgical and surgical treatments are discussed for primary malignancies and metastases. Current treatments are presented for seven varieties of primary malignant tumors. This is a good introductory overview.
Pediatric Tumors Involving the Spinal Column.
Sciubba DM, Hsieh P, McLoughlin GS, Jallo GI.
Neurosurg Clin N Am. 2008; 19: 81-92.
PMID: 18156051
This narrative review discusses pediatric spinal tumors. The topics include epidemiology, clinical presentation, neuroblastic tumors, sarcomas, primary tumors, chordomas, congenital teratomas, and instrumentation. For each variety of tumor, they present the pathology and origin, diagnostic features, and treatment recommendations This is a valuable guide for these rare pathologies.
web: http://www.neurosurgery.theclinics.com/article/S1042-3680(07)00092-7/abstract