Metastatic Spinal Tumours

Courtesy: Orthopaedic Principles ICL Kochi by Dr Hitesh Gopalan

• Metastatic disease of the spine is quite common, Skeletal system is the third most common organ affected by metastatic cancer, after the lungs and the liver
• Symptomatic spinal metastasis is the initial manifestation of malignancy in 12% to 20% of cases and metastasis is the most commonly encountered malignant lesion in the spine.
• The primary tumours most likely to metastasize to the vertebral column are breast (16% to 37% of breast cancer patients develop spine metastases), prostate (9% to 15%), lung (12% to 15%), kidney (3% to 6%), and thyroid (4%).
• Thoracic spine is most commonly involved, possibly because it contains the greatest volume of bone marrow for receiving metastatic deposits
• Symptomatic lesions typically are found in the thoracic (68% to 70%), lumbosacral (16% to 22%) and cervical (8% to 15%) spine.

PATHOGENESIS
• Malignant cells are generally thought to spread to the spine hematogenously, either through segmental arteries to the highly vascular vertebral marrow or by retrograde spread through the valveless extradural Batson’s venous plexus.