Vertebral metastases

Tumors cells no longer confined to an affected organ can be released through lymph and the blood stream, disseminate and form metastases. Metastases to the spine are frequent, may be painful and may occur in an isolated or multiple level manner, they may lead to structural failure of the spinal column and cause com­ pression of nerve structures resulting in progressive paralysis or in painful radi­ culopathies. The dinical evaluation as weIl as to tumor pathophysiology are weIl explai­ ned in two general chapters and then each specific primary tumor is analyzed in a specific chapter. The choice was made to offer a multidisciplinary approach. One may thus find similar aspects repeated in different chapters, yet this is ne ces­ sary since each part of this textbook can be used as a specific reference. I was impressed by the carefully detailed humane approach to the patient information with care for the patient's dignity. Truthful information is explained dearly enough to give all the elements the patient needs to understand and accept neces­ sary treatments with a responsible attitude. Previously, when confronted with a patient suffering from a debilitating spine metastasis of a malignant tumor it has been almost always too late to offer anything more than compassionate ineffica­ cy. Surgical treatment was balanced with life expectancy and then only rarely indicated in certain specific cases. Front Matter....Pages 1-13 Introduction....Pages 15-16 Comprehensive patient care and information presented to patients....Pages 17-21 Metastasis of cancerous cells: Characteristics of osseous invasion....Pages 22-38 Pathophysiology of vertebral metastases....Pages 39-51 Symptoms of vertebral metastases....Pages 52-59 Imaging of vertebral metastases....Pages 60-84 Bone scintigraphy of vertebral metastases....Pages 85-91 Percutaneous vertebral biopsy under radiological guidance....Pages 92-96 Pathology....Pages 97-100 Front Matter....Pages 101-101 Vertebral metastases of breast cancers....Pages 102-105 Vertebral metastases of renal cancers....Pages 106-111 Vertebral metastases of thyroid cancer....Pages 112-116 Vertebral metastases of prostate cancer....Pages 117-121 Vertebral metastases of lung cancer....Pages 122-127 Vertebral metastases of hematologic malignancies....Pages 128-133 Osseous metastases of digestive cancers....Pages 134-137 Osseous metastases of rare tumors....Pages 138-140 Vertebral metastases of cancers of unknown primary origin....Pages 141-143 Front Matter....Pages 144-144 Indications of surgery in the treatment of vertebral metastases....Pages 145-159 Surgery of cervical vertebral metastases....Pages 160-165 Front Matter....Pages 144-144 Anterior approaches to the thoracic and thoracolumbar spine....Pages 166-169 Treatment of thoracic vertebral metastases by thoracoscopy: Technique and results....Pages 170-182 Posterior thoracic and lumbar approach....Pages 183-193 Vertebrectomy in the treatment of vertebral metastases....Pages 194-204 Recurrences, new metastases and complications....Pages 205-210 Perioperative nursing care and psychological management....Pages 211-223 Perioperative anesthetic management: Assessment of risk, intraoperative period, postoperative period and systemic complications....Pages 224-242 Functional rehabilitation management of patients operated for vertebral metastases....Pages 243-247 Vertebroplasty....Pages 248-258 Preoperative embolization of hypervascularized vertebral tumors....Pages 259-263 Bisphosphonates and osseous metastases....Pages 264-269 Symptomatic treatments of the pain of vertebral metastases....Pages 270-284 Radiation therapy for vertebral metastases....Pages 285-291 Strategical and decisional trees....Pages 292-293 Analysis of results....Pages 294-297 Analysis of the literature and annotated critical bibliography....Pages 298-320 This book, the result of close collaboration between two very specialized centers, one in spinal surgery, the other in oncology, was written to take stock of the current data on vertebral metastases. It is intended as both a pratical guide for all those involved in this field of care and a didactic reference for those who are less familiar with either of these specialties. All aspects of current knowledge of metastases are considered. Regarding diagnostics, MRI is at present indispensable and nessecitates a broad iconography. In the therapeutics section, so as to restituate vertebral metastasis in its proper general context, a chapter is devoted to the particularities of the treatment in terms of the primary cancer. This is fundamental since the sensitivity of tumors to systemic treatment is clearly not the same from one case to another. The role of surgery in vertebral metastases has changed completely over the last ten years with the increasing use osteosynthesis combined with decompressive procedures. The explanation of these techniques and their indications is largely based upon providing a suitable response to the mechanical problems posed at each location in the spinal column. Vertebroplasty and biphosphonates, two recent additions to the therapeutic armamentarium are detailed, along with conventional treatments such as radiation therapy and the comprehensive approach to pain management. In the present context of technological advances against vertebral metastases, physicians must not lose sight of the patient as an individual. This imperative prompted us to include a chapter on nursing and psychological cared. Another chapter addresses the continuity of care, placing responsibility for the patient's management at present solely in the hands of a multidisciplinary team. A methodological review of the literature concludes that there still remains much work to be done for better assessment of the responsibility for the welfare of these patients. Two leading US spinal surgeons have accepted to endorse this manuscript: J.P. Farcy and N. Sundaresan. The question of their contributing to the book was naturally raised. However, it seemed preferable to preserve the homogenous spirit driving the original group of collaborators