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Metastasis means that the cancer has spread to a different part of the body from where it started. Metastases that affect the spinal cord can be of two main types: epidural or intramedullary.

Epidural metastases

Epidural metastases are usually caused by a tumour with metastases in the vertebral bodies. Neurological complications are mainly due to compression of the spinal cord by extension into the epidural space, since its invasion is very rare. The dura is very resistant, and tumor mass does not usually cross it.

Intramedullary metastases

Intramedullary metastases (direct invasion of the spinal cord) account for less than 5% of neoplastic spinal pathology, and are produced by tumor growth through nerve roots or by hematogenous seeding.
 
Oncological patients have spinal metastases in 25-70% of cases and, among them, approximately 10-20% develop epidural spinal cord compression (ESCC). The spine is the most common site of bone metastases, regardless of the tumor responsible. The neoplasms most frequently involved are lung, breast and prostate cancer, followed by kidney cancer, multiple myeloma and non-Hodgkin lymphoma. 

Symptoms

The clinical presentation mode is pain in 85% of patients and only 15% is neurological involvement. When vertebral tumors hurt, they are the result of one or more of the following factors:

1. Expansion of the bone cortex by tumor mass with compression or invasion of neighboring tissues.

2. Compression or invasion of roots.

3. Pathological fracture.

4. Development of spinal instability.

5. Marrow or root compression.

The pain is usually in the midline but patients with tumors that compromise the nerve roots have acute and stabbing pain with root distribution.

In untreated patients, pain often intensifies with an average duration of 7 weeks from the onset of pain to the initial manifestation of neurological deficit due to spinal cord compression.

Signs of spinal compression include motor, sensory and autonomic dysfunction (for example, bladder and intestinal dysfunction).

Diagnosis

MRI is currently the gold standard for the evaluation of metastatic vertebral disease.

A combination of magnetic resonance imaging for tumor and soft tissue visualization as well as CT for the definition of bone anatomy is the most effective method of evaluation of these patients.

Because pain is an early and reliable sign, epidural metastasis can be diagnosed and treated before developing neurological deficit.

CT and bone scintigraphy are used as complementary tests.

 

Radiography

This should be the first test to ask for a suspected vertebral tumor. A simple radiological study, in a large majority of cases, allows the diagnosis of a vertebral tumor. We can obtain considerable information on the nature and behavior of the lesion, in many cases identifying the type of tumor. Although this is not possible, at least the benign or malignant nature of the injury can be determined. 

 

At the London Spine Unit, we have the best specialists to diagnose and treat spinal metastases. Book an appointment  to get a checkup.

What are epidural metastases?

Epidural metastases are usually caused by a tumor with metastases in the vertebral bodies. Neurological complications are mainly due to compression of the spinal cord by extension into the epidural space, since its invasion is very rare. The dura is very resistant, and tumor mass does not usually cross it.

What are intramedullary metastases?

Intramedullary metastases (direct invasion of the spinal cord) account for less than 5% of neoplastic spinal pathology, and are produced by tumor growth through nerve roots or by hematogenous seeding.

What are the symptoms?

The clinical presentation mode is pain in 85% of patients and only 15% is neurological involvement. When vertebral tumors hurt, they are the result of one or more of certain factors. The pain is usually in the midline but patients with tumors that compromise the nerve roots have acute and stabbing pain with root distribution. In untreated patients, pain often intensifies with an average duration of 7 weeks from the onset of pain to the initial manifestation of neurological deficit due to spinal cord compression. Signs of spinal compression include motor, sensory and autonomic dysfunction (for example, bladder and intestinal dysfunction).

How to diagnose spinal metastases?

MRI is currently the gold standard for the evaluation of metastatic vertebral disease. A combination of magnetic resonance imaging for tumor and soft tissue visualization as well as CT for the definition of bone anatomy is the most effective method of evaluation of these patients. Because pain is an early and reliable sign, epidural metastasis can be diagnosed and treated before developing neurological deficit. CT and bone scintigraphy are used as complementary tests.

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