Spinal Metastases
Spinal metastases are secondary tumors formed when a primary cancer elsewhere in the body spreads to the spine. They arise most often from lung, breast and prostate cancers; the main features are progressive back pain, neurological deficit and pathological fracture.
Ostatnia aktualizacja: 2026-06-07
Definition and Frequency
Spinal metastases are secondary tumors formed when a cancer elsewhere in the body (the primary tumor) spreads to the spine. They are one of the most common neurological complications in cancer patients and account for a significant share of bone metastases. They arise most often from lung, breast and prostate cancers, followed by kidney and thyroid cancers and hematological malignancies. The thoracic (mid-back) spine is most commonly involved.
Mechanism of Spread
Tumor cells most often reach the spine through the bloodstream (hematogenous); the rich bone marrow of the vertebral body and the Batson venous plexus facilitate this spread. Less commonly, there is direct spread from an adjacent tumor. Metastasis usually starts in the vertebral body; as it grows it can extend into the spinal canal and compress the spinal cord or nerve roots (epidural spinal cord compression). Weakening of the bone can lead to vertebral collapse and instability.
Symptoms
The most common and usually first symptom is progressive back pain; worsening at night and at rest is a warning sign that distinguishes it from mechanical back pain. Pressure on a nerve root causes radicular pain radiating into an arm/leg. As spinal cord compression progresses, neurological deficits develop such as muscle weakness, numbness, gait disturbance and impaired bladder/bowel control. Progressive weakness and sphincter dysfunction are an emergency.
Diagnosis
Contrast-enhanced whole-spine MRI is the gold standard for diagnosis; it shows the location of the metastasis, the degree of spinal cord/nerve root compression (Bilsky grading) and the extent of disease. CT supports assessment of bone destruction and instability and surgical planning. PET-CT and bone scintigraphy assess the extent of disease. If the primary tumor is unknown or the diagnosis is uncertain, image-guided needle biopsy is performed. Prognostic and instability scoring systems (for example SINS) are used to guide treatment decisions.
Treatment
Treatment is planned with a multidisciplinary approach, with goals of pain control, preservation/improvement of neurological function, spinal stability and quality of life. Surgery (decompression and stabilization with instrumentation) is used for progressive neurological deficit, spinal cord compression or mechanical instability. Radiotherapy (conventional or stereotactic body radiotherapy) plays a central role in local tumor control. Vertebroplasty/kyphoplasty reduces pain in selected fractures. Systemic therapy (chemotherapy, hormonal/targeted therapy, immunotherapy) and bone-protective drugs are arranged according to the primary cancer type.
Prognosis
Prognosis depends largely on the type of primary cancer and its response to treatment, the extent of metastasis and the patient's neurological status; it therefore varies widely between patients. Early treatment planning, particularly intervention before a neurological deficit becomes established, is decisive in preserving ambulation and quality of life. The approach is often palliative and function-preserving. Outcomes differ by patient and cannot be guaranteed.
Źródła
- Greenberg MS. Greenberg's Handbook of Neurosurgery. 10th ed. Thieme; 2023:921-928.
- Winn HR, ed. Youmans Neurological Surgery. 6th ed. Saunders; 2011.
- Patchell RA, et al. Direct decompressive surgical resection in metastatic spinal cord compression. Lancet. 2005.
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