Multidisciplinary Approach to Patients With Metastatic Spinal Cord Compression: A Diagnostic Therapeutic Algorithm to Improve the Neurological Outcome
IntroductionThe morbidity associated with metastatic spinal disease is significant because of spinal cord and/or nerve root compression. The purpose of this paper is to define a diagnostic-therapeutic path for patients with vertebral metastases and from this path to build an algorithm to reduce the...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-06-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2022.902928/full |
| _version_ | 1811249527815929856 |
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| author | Rossella Rispoli Chiara Reverberi Giada Targato Serena D’Agostini Gianpiero Fasola Marco Trovò Mario Calci Renato Fanin Barbara Cappelletto |
| author_facet | Rossella Rispoli Chiara Reverberi Giada Targato Serena D’Agostini Gianpiero Fasola Marco Trovò Mario Calci Renato Fanin Barbara Cappelletto |
| author_sort | Rossella Rispoli |
| collection | DOAJ |
| description | IntroductionThe morbidity associated with metastatic spinal disease is significant because of spinal cord and/or nerve root compression. The purpose of this paper is to define a diagnostic-therapeutic path for patients with vertebral metastases and from this path to build an algorithm to reduce the devastating consequences of spinal cord compression.Materials and MethodsThe algorithm is born from the experience of a primary care center. A spine surgeon, an emergency room (ER) physician, a neuroradiologist, a radiation oncologist, and an oncologist form the multidisciplinary team. The ER physician or the oncologist intercept the patient with symptoms and signs of a metastatic spinal cord compression. Once the suspicion is confirmed, the following steps of the flow-chart must be triggered. The spine surgeon takes charge of the patient and, on the base of the anamnestic data and neurological examination, defines the appropriate timing for magnetic resonance imaging (MRI) in collaboration with the neuroradiologist. From the MRI outcome, the spine surgeon and the radiation oncologist consult each other to define further therapeutic alternatives. If indicated, surgical treatment should precede radiation therapy. The oncologist gets involved after surgery for systemic therapy.ResultsIn 2021, the Spine and Spinal Cord Surgery department evaluated 257 patients with vertebral metastasis. Fifty-three patients presented with actual or incipient spinal cord compression. Among these, 27 were admitted due to rapid progression of symptoms, neurological deficits and/or spine instability signs. The level was thoracic in 21 cases, lumbar in 4 cases, cervical in 1 case, sacral in 1 case. Fifteen were operated on, 10 of these programmed and 5 in emergency.DiscussionPatients with a history of malignancy can present to the ER or to the oncology department with symptoms that must be correctly framed in the context of a metastatic involvement. Even when there is no previous cancer history, the patient’s pain characteristics and clinical signs must be interpreted to yield the correct diagnosis of vertebral metastasis with incipient or current spinal cord compression. The awareness of the alert symptoms and the application of an integrated paradigm consent to frame the patients with spinal cord compression, obtaining the benefits of a homogeneous step-by-step diagnostic and therapeutic path. Early surgical or radiation therapy treatment gives the best hope for preventing the worsening, or even improving, the deficits.ConclusionsMetastatic spinal cord compression can cause neurological deficits compromising quality of life. Treatment strategies should be planned comprehensively. A multidisciplinary approach and the application of the proposed algorithm is of paramount importance to optimize the outcomes of these patients. |
| first_indexed | 2024-04-12T15:48:07Z |
| format | Article |
| id | doaj.art-f41ab2baf8ca490fbe5b3f8c15208516 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-04-12T15:48:07Z |
| publishDate | 2022-06-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-f41ab2baf8ca490fbe5b3f8c152085162022-12-22T03:26:36ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2022-06-011210.3389/fonc.2022.902928902928Multidisciplinary Approach to Patients With Metastatic Spinal Cord Compression: A Diagnostic Therapeutic Algorithm to Improve the Neurological OutcomeRossella Rispoli0Chiara Reverberi1Giada Targato2Serena D’Agostini3Gianpiero Fasola4Marco Trovò5Mario Calci6Renato Fanin7Barbara Cappelletto8SOC Chirurgia Vertebro-Midollare, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Universitario “Santa Maria della Misericordia” di Udine, Udine, ItalySOC Radioterapia, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Universitario “Santa Maria della Misericordia” di Udine, Udine, ItalySOC Oncologia, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Universitario “Santa Maria della Misericordia” di Udine, Udine, ItalySOC Neuroradiologia, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Universitario “Santa Maria della Misericordia” di Udine, Udine, ItalySOC Oncologia, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Universitario “Santa Maria della Misericordia” di Udine, Udine, ItalySOC Radioterapia, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Universitario “Santa Maria della Misericordia” di Udine, Udine, ItalySOC Pronto Soccorso e Medicina d’Urgenza, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Universitario “Santa Maria della Misericordia” di Udine, Udine, ItalyClinica di Ematologia, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Universitario “Santa Maria della Misericordia” di Udine, Udine, ItalySOC Chirurgia Vertebro-Midollare, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Universitario “Santa Maria della Misericordia” di Udine, Udine, ItalyIntroductionThe morbidity associated with metastatic spinal disease is significant because of spinal cord and/or nerve root compression. The purpose of this paper is to define a diagnostic-therapeutic path for patients with vertebral metastases and from this path to build an algorithm to reduce the devastating consequences of spinal cord compression.Materials and MethodsThe algorithm is born from the experience of a primary care center. A spine surgeon, an emergency room (ER) physician, a neuroradiologist, a radiation oncologist, and an oncologist form the multidisciplinary team. The ER physician or the oncologist intercept the patient with symptoms and signs of a metastatic spinal cord compression. Once the suspicion is confirmed, the following steps of the flow-chart must be triggered. The spine surgeon takes charge of the patient and, on the base of the anamnestic data and neurological examination, defines the appropriate timing for magnetic resonance imaging (MRI) in collaboration with the neuroradiologist. From the MRI outcome, the spine surgeon and the radiation oncologist consult each other to define further therapeutic alternatives. If indicated, surgical treatment should precede radiation therapy. The oncologist gets involved after surgery for systemic therapy.ResultsIn 2021, the Spine and Spinal Cord Surgery department evaluated 257 patients with vertebral metastasis. Fifty-three patients presented with actual or incipient spinal cord compression. Among these, 27 were admitted due to rapid progression of symptoms, neurological deficits and/or spine instability signs. The level was thoracic in 21 cases, lumbar in 4 cases, cervical in 1 case, sacral in 1 case. Fifteen were operated on, 10 of these programmed and 5 in emergency.DiscussionPatients with a history of malignancy can present to the ER or to the oncology department with symptoms that must be correctly framed in the context of a metastatic involvement. Even when there is no previous cancer history, the patient’s pain characteristics and clinical signs must be interpreted to yield the correct diagnosis of vertebral metastasis with incipient or current spinal cord compression. The awareness of the alert symptoms and the application of an integrated paradigm consent to frame the patients with spinal cord compression, obtaining the benefits of a homogeneous step-by-step diagnostic and therapeutic path. Early surgical or radiation therapy treatment gives the best hope for preventing the worsening, or even improving, the deficits.ConclusionsMetastatic spinal cord compression can cause neurological deficits compromising quality of life. Treatment strategies should be planned comprehensively. A multidisciplinary approach and the application of the proposed algorithm is of paramount importance to optimize the outcomes of these patients.https://www.frontiersin.org/articles/10.3389/fonc.2022.902928/fullspinal metastasisspinal cord compressionpathological spine fracturesdiagnostic-therapeutic algorithmneurological deficits |
| spellingShingle | Rossella Rispoli Chiara Reverberi Giada Targato Serena D’Agostini Gianpiero Fasola Marco Trovò Mario Calci Renato Fanin Barbara Cappelletto Multidisciplinary Approach to Patients With Metastatic Spinal Cord Compression: A Diagnostic Therapeutic Algorithm to Improve the Neurological Outcome Frontiers in Oncology spinal metastasis spinal cord compression pathological spine fractures diagnostic-therapeutic algorithm neurological deficits |
| title | Multidisciplinary Approach to Patients With Metastatic Spinal Cord Compression: A Diagnostic Therapeutic Algorithm to Improve the Neurological Outcome |
| title_full | Multidisciplinary Approach to Patients With Metastatic Spinal Cord Compression: A Diagnostic Therapeutic Algorithm to Improve the Neurological Outcome |
| title_fullStr | Multidisciplinary Approach to Patients With Metastatic Spinal Cord Compression: A Diagnostic Therapeutic Algorithm to Improve the Neurological Outcome |
| title_full_unstemmed | Multidisciplinary Approach to Patients With Metastatic Spinal Cord Compression: A Diagnostic Therapeutic Algorithm to Improve the Neurological Outcome |
| title_short | Multidisciplinary Approach to Patients With Metastatic Spinal Cord Compression: A Diagnostic Therapeutic Algorithm to Improve the Neurological Outcome |
| title_sort | multidisciplinary approach to patients with metastatic spinal cord compression a diagnostic therapeutic algorithm to improve the neurological outcome |
| topic | spinal metastasis spinal cord compression pathological spine fractures diagnostic-therapeutic algorithm neurological deficits |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2022.902928/full |
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