Spinal metastasis in the elderly

Abstract Bony metastases are a frequent problem in elderly patients affected by cancer, and those with bony metastases involve the spine in approx. 50%. The most frequent spinal metastases (60%) are from breast, lung, or prostate cancer. The chance that an elderly patient (60–79 years old) is affect...
Ausführliche Beschreibung

Abstract Bony metastases are a frequent problem in elderly patients affected by cancer, and those with bony metastases involve the spine in approx. 50%. The most frequent spinal metastases (60%) are from breast, lung, or prostate cancer. The chance that an elderly patient (60–79 years old) is affected by bony metastases is four times higher in men and three times higher in women than a middle-aged patient (40–59 years old). Since the medical treatment with all the adjuvant treatment options prolong the survival of this particular patient group, the spinal metastases may become a mechanical issue, thus requesting surgical treatment. Different classification systems have been proposed to rationalize surgical indications, some concentrating solely on the local spinal tumor involvement and some including the overall clinical situation. Since most of the surgical options are of palliative character, it is more important to base the decision on an overall clinical classification including the different treatment modalities—irradiation, chemotherapy, steroids, bisphosphonates, and surgery—to make a shared decision. In case surgery is indicated—neural compression, pathological fracture, instability, and progressive deformity, nursing reasons—the most straightforward procedures should be chosen, which may not need an intensive care unit stay. In the thoracolumbar spine a posterior decompression and posterolateral vertebral body resection through a posterior approach only, with a concomitant reconstruction and stabilization, has shown to work sufficiently well. In the middle and lower cervical spine the anterior approach with anterior decompression and anterior column reconstruction is most effective and has a low morbidity, whereas the occipitocervical junction can generally be treated by posterior resection and stabilization. The outcome should be determined by the survival time in an ambulatory, independent status, where pain is controlled, and the patient is not hospitalized. Surgical management shows the greatest improvement in pain reduction, but also in other domains of quality of life. Since prospective randomized studies comparing different treatment modalities for spinal metastases including surgery are not available and are ethically difficult to achieve, each case remains an interdisciplinary, shared decision making process for what is considered best for a patient or elderly patient. However, whenever surgery is an option, it should be planned before irradiation since surgery after irradiation has a significant higher complication rate. Ausführliche Beschreibung

Autor*in:	Aebi, Max [verfasserIn]

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2003

Schlagwörter:	Spinal metastases Vertebral metastases Elderly Spinal tumor Vertebral tumor

Übergeordnetes Werk:	Enthalten in: European spine journal - Berlin : Springer, 1992, 12(2003), Suppl 2 vom: 23. Sept., Seite S202-S213
Übergeordnetes Werk:	volume:12 ; year:2003 ; number:Suppl 2 ; day:23 ; month:09 ; pages:S202-S213

Links:	Volltext

DOI / URN:	10.1007/s00586-003-0609-9

Katalog-ID:	SPR006875610