Management of spinal metastases

Spinal metastasis is a frequent oncologic and neurosurgical emergency in patients with cancer. Most patients present with back pain and the diagnosis is established with a screening MRI of the spine. Treatment options include steroids, biphosphonates, radiation therapy, surgery and radiosurgery. Pain management is a very important aspect and includes opioids, anti-inflammatory agents, newer anticonvulsants and tricyclic anti-depressants, as well as placement of intrathecal morphine pumps in selected cases. Our experience with 45 patients with metastatic disease to the spine treated surgically at the H. Lee Moffitt Cancer Center and Research Institute is also reviewed. Current surgical techniques address both tumor resection and stabilization of the spine. In most instances, treatment must be individualized and take into consideration the patient’s wishes, and expected quality and duration of remainder life.