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Contemporary Treatment Strategy for Spinal Metastasis: The “LMNOP” System

Published online by Cambridge University Press:  02 December 2014

Gillian R. Paton ,
Evan Frangou  and
Daryl R. Fourney
Gillian R. Paton
Affiliation:
Division of Neurosurgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
Evan Frangou
Affiliation:
Division of Neurosurgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
Daryl R. Fourney*
Affiliation:
Division of Neurosurgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
*
Division of Neurosurgery, University of Saskatchewan, Royal University Hospital, 103 Hospital Drive, Saskatoon, Saskatchewan, S7N 0W8, Canada
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Abstract

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The choice of treatment for spinal metastasis is complex because (1) it depends on several inter-related clinical and radiologic factors, and (2) a wide range of management options has evolved in recent years. While radiation therapy and surgery remain the cornerstones of treatment, radiosurgery and percutaneous vertebral augmentation have also established a role. Classification systems have been developed to aid in the decision-making process, and each has different strengths and weaknesses. The comprehensive scoring systems developed to date provide an estimate of life expectancy, but do not provide much advice on the choice of treatment. We propose a new decision model that describes the key factors in formulating the management plan, while recognizing that the care of each patient remains highly individualized. The system also incorporates the latest changes in technology. The LMNOP system evaluates the number of spinal Levels involved and the Location of disease in the spine (L), Mechanical instability (M), Neurology (N), Oncology (O), Patient fitness, Prognosis and response to Prior therapy (P).

Résumé:

Résumé:

Le choix du traitement des métastases spinales est complexe parce que 1) il dépend de plusieurs facteurs cliniques et radiologiques qui sont inter-reliés et 2) une grande variété d’options thérapeutiques ont été développées depuis quelques années. Bien que la radiothérapie et la chirurgie demeurent la base du traitement, la radiochirurgie et la vertébroplastie percutanée ont maintenant un rôle bien établi. Des systèmes de classification ont été développés pour aider le processus décisionnel et chaque traitement a des forces et des faiblesses différentes. Les systèmes de pointage développés jusqu’à maintenant fournissent un estimé de l’espérance de vie, mais peu de conseils sur le choix du traitement. Nous proposons un nouveau modèle de décision qui décrit les facteurs clé pour élaborer le plan de traitement, tout en reconnaissant que les soins prodigués à chaque patient demeurent très individualisés. Ce système tient également compte des changements technologiques les plus récents. Le système LMNOP évalue le nombre de niveaux spinaux atteints et le Lieu de la maladie dans la colonne vertébrale (L), l’instabilité Mécanique (M), la Neurologie (N), l’Oncologie (O), l’état du Patient, le Pronostic et la réponse aux traitements antérieurs (P).

Type
Review Article
Information
Canadian Journal of Neurological Sciences , Volume 38 , Issue 3 , May 2011 , pp. 396 - 403
Copyright
Copyright © The Canadian Journal of Neurological 2011

References

1 Drew, M, Dickson, RB. Osseous complications of malignancy. In: Lokich, JJ, editor. Clinical cancer medicine: treatment tactics. Boston; 1980. p. 97–124.Google Scholar
2 Bhalla, SK. Metastatic disease of the spine. Clin Orthop Relat Res. 1970;73:52–60.CrossRefGoogle ScholarPubMed
3 Enneking, WF. Metastatic carcinoma. In: Enneking, WF, editor. Musculoskeletal tumor surgery. New York; 1983. p. 1541.Google Scholar
4 Barron, KD, Hirano, A, Araki, S, Terry, RD. Experiences with metastatic neoplasms involving the spinal cord. Neurology. 1959;9(2):91–106.CrossRefGoogle ScholarPubMed
5 Wong, DA, Fornasier, VL, MacNab, I. Spinal metasases; the obvious, the occult and the imposters. Spine. 1990;15(1):1–4.CrossRefGoogle Scholar
6 Perrin, RG, McBroom, RJ. Anterior versus posterior decompression for symptomatic spinal metastasis. Can J Neurol Sci. 1987;14 (1):750–80.CrossRefGoogle ScholarPubMed
7 Feiz-Erfan, I, Rhines, LD, Weinberg, JS. The role of surgery in the management of metastatic spinal tumors. Semin Oncol. 2008;35 (2):108–17.CrossRefGoogle ScholarPubMed
8 Finkelstein, JA, Zaveri, G, Wai, E, Vidmar, M, Kreder, H, Chow, E. A population-based study of surgery for spinal metastases. Survival rates and complications. J Bone Joint Surg Br. 2003;85 (7):1045–50.Google Scholar
9 Muacevic, A, Staehler, M, Drexler, C, Wowra, B, Reiser, M, Tonn, JC. Technical description, phantom accuracy, and clinical feasibility for fiducial-free frameless real-time image-guided spinal radiosurgery. J Neurosurg Spine. 2006;5(4):303–12.Google Scholar
10 Fourney, DR, Schomer, DF, Nader, R, et al. Percutaneous vertebroplasty and kyphoplasty for painful vertebral body fractures in cancer patients. J Neurosurg. 2003;98 Suppl 1: 21–30.Google Scholar
11 Bartels, RH, van der Linden, YM, van der Graaf, WT. Spinal extradural metastasis: review of current treatment options. CA Cancer J Clin. 2008;58(4):245–59. Epub 2008 Mar 19.CrossRefGoogle ScholarPubMed
12 Kostuik, JP, Errico, TJ, Gleason, TF, Errico, CC. Spinal stabilization of vertebral column tumors. Spine. 1988;13(3):250–6.Google Scholar
13 Leithner, A, Radl, R, Gruber, G, et al. Predictive value of seven preoperative prognostic scoring systems for spinal metastases. Eur Spine J. 2008;17(11):1488–95. Epub 2008 Sep 12.Google Scholar
14 Tokuhashi, Y, Matsuzaki, H, Oda, H, Oshima, M, Ryu, J. A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis. Spine. 2005;30(19):2186–91.Google Scholar
15 Tomita, K, Kawahara, N, Kobayashi, T, Yoshida, A, Murakami, H, Akamaru, T. Surgical strategy for spinal metastases. Spine. 2001; 26(3):298–306.Google Scholar
16 Tokuhashi, Y, Matsuzaki, H, Toriyama, S, Kawano, H, Ohsaka, S. Scoring system for the preoperative evaluation of metastatic spine tumor prognosis. Spine. 1990;15(11):1110–13.CrossRefGoogle ScholarPubMed
17 Bilsky, MH, Smith, M. Surgical approach to epidural spinal cord compression. Hematol Oncol Clin N Am. 2006;20(6):1307–17.CrossRefGoogle ScholarPubMed
18 Fourney, DR, Gokaslan, ZL. Anterior approaches for thoracolumbar metastatic spine tumors. Neurosurg Clin N Am. 2004;15(4):4 43–51.Google Scholar
19 Fourney, DR, Gokaslan, ZL. Tumors of the lumbar and lumbosacral spine. In: Fessler, RG, Sekhar, L, editors. Atlas of neurosurgical techniques: spine and peripheral nerves. New York; 2006. p. 567–79.Google Scholar
20 Wu, AS, Fourney, DR. Evolution of treatment for metastatic spine disease. Neurosurg Clin N Am. 2004;15(4):401–11.CrossRefGoogle ScholarPubMed
21 van der Sande, JJ, Kroger, R, Boogerd, W. Multiple spinal epidural metastases; an unexpectedly frequent finding. J Neurol Neurosurg Psychiatry. 1990;53(11):1001–3.CrossRefGoogle ScholarPubMed
22 Ruff, RL, Lanska, DJ. Epidural metastases in prospectively evaluated veterans with cancer and back pain. Cancer. 1989;63 (11):2234–41.3.0.CO;2-T>CrossRefGoogle ScholarPubMed
23 Fehlings, MG, David, KS, Vialle, L, Vialle, E, Setzer, M, Vrionis, FD. Decision making in the surgical treatment of cervical spine metastases. Spine. 2009;34 Suppl 22:S108–17.Google Scholar
24 Fourney, DR, York, JE, Cohen, ZR, Suki, D, Rhines, LD, Gokaslan, ZL. Management of atlantoaxial metastases with posterior occipitocervical stabilization. J Neurosurg. 2003;98(2 Suppl): 165–70.Google Scholar
25 Bilsky, MH, Shannon, FJ, Sheppard, S, Prabhu, V, Boland, PJ. Diagnosis and management of a metastatic tumor in the atlantoaxial spine. Spine. 2002;27(10):1062–9.Google Scholar
26 Polly, DW Jr, Chou, D, Sembrano, JN, Ledonio, CG, Tomita, K. An analysis of decision making and treatment in thoracolumbar metastases. Spine. 2009;34 Suppl 22:S118–27.CrossRefGoogle ScholarPubMed
27 Fourney, DR, Gokaslan, ZL. Use of “MAPs” for determining the optimal surgical approach to metastatic disease of the thoacolumbar spine: anterior, posterior, or combined. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004. J Neurosurg Spine. 2005;2(1):40–9.Google Scholar
28 Huth, JF, Dawson, EG, Eilber, FR. Abdominosacral resection for malignant tumors of the sacrum. Am J Surg. 1984;148(1): 157–61.CrossRefGoogle ScholarPubMed
29 Nader, R, Rhines, LD, Mendel, E. Metastatic sacral tumors. Neurosurg Clin N Am. 2004;15(4):453–7.Google Scholar
30 Raque, GH Jr, Vitaz, TW, Shields, CB. Treatment of neoplastic diseases of the sacrum. J Surg Oncol. 2001;76(4):301–7.Google Scholar
31 Fisher, CG, DiPaola, CP, Ryken, TC, et al. A novel classification system for spinal instability in neoplastic disease; and evidence-based approach and expert consensus from the Spine Oncology Study Group. Spine. Epub 2010 Jun 18.Google Scholar
32 Asdourian, PL, Mardjetko, S, Rauschning, W, Jonsson, H Jr, Hammerberg, KW, Dewald, RL. An evaluation of spinal deformity in metastatic breast cancer. J Spinal Disord. 1990;3(2): 119–34.Google Scholar
33 Cybulski, GR. Methods of surgical stabilization for metastatic disease of the spine. Neurosurgery. 1989;25(2):240–52.CrossRefGoogle ScholarPubMed
34 Fourney, DR, Gokaslan, ZL. Spinal instability and deformity due to neoplastic conditions. Neurosurg Focus. 2003;14(1):E8.CrossRefGoogle ScholarPubMed
35 Kostuik, JP, Weinstein, JN. Differential diagnosis and surgical treatment of metastatic spine tumors. In: Frymoyer, JW, editor. The adult spine: principles and practice. New York; 1991. p. 861–88.Google Scholar
36 Taneichi, H, Kaneda, K, Takeda, N, Abumi, K, Satoh, S. Risk factors and probability of vertebral body collapse in metastases of the thoracic and lumbar spine. Spine. 1997;22(3):239–45.Google Scholar
37 Bach, F, Larsen, BH, Rohde, K, et al. Metastatic spinal cord compression. Occurrence, symptoms, clinical presentations and prognosis in 398 patients with spinal cord compression. Acta Neurochir (Wien). 1990;107(1-2):37–43.Google Scholar
38 Fourney, DR, Abi-Said, D, Lang, FF, McCutcheon, IE, Gokaslan, ZL. The use of pedicle screw fixation in the management of malignant spinal disease: experience in 100 consecutive cases. J Neurosurg. 2001;94 Suppl 1:25–37.Google Scholar
39 Gokaslan, ZL, York, JE, Walsh, GL, et al. Transthoracic vertebrectomy for metastatic spinal tumors. J Neurosurg. 1998; 89(4):599–609.CrossRefGoogle ScholarPubMed
40 Helweg-Larsen, S, Sørensen, PS. Symptoms and signs in metastatic spinal cord compression: a study from first symptom until diagnosis in 153 patients. Eur J Cancer. 1994;30A(3):396–8.CrossRefGoogle ScholarPubMed
41 Posner, JB, editor. Neurologic complications of cancer. Philadelphia: FA Davis; 1995.Google Scholar
42 Gokaslan, ZL. Spine surgery for cancer. Curr Opin Oncol. 1996;8 (3):178–81.Google Scholar
43 Fourney, DR, Frangou, E, Ryken, T, Fisher, CP. A revised spinal instability neoplastic score (SINS): Results of a validity and reliability analysis. Abstract. Can J Surg. 2010;53 Suppl June:15.Google Scholar
44 Ahn, H, Mousavi, P, Roth, S, Reidy, D, Finkelstein, J, Whyne, C. Stability of the metastatic spine pre and post vertebroplasty. J Spinal Disord Tech. 2006;19(3):178–82.Google Scholar
45 Gerszten, PC, Welch, WC. Current surgical management of metastatic spinal disease. Oncology (Williston Park). 2000;14 (7):1013–24.Google ScholarPubMed
46 Schaberg, J, Gainor, BJ. A profile of metastatic carcinoma of the spine. Spine. 1985;10(1):19–20.Google Scholar
47 Black, P. Spinal metastasis: current status and recommended guidelines for management. Neurosurgery. 1979;5(6):726–46.Google Scholar
48 Findlay, GF. Adverse effects of the management of malignant spinal cord compression. J Neurol Neurosurg Psychiatry. 1984;47(8): 761–8.Google Scholar
49 Gilbert, RW, Kim, JH, Posner, JB. Epidural spinal cord compression from metastatic tumor: diagnosis and treatment. Ann Neurol. 1978;3(1):40–51.CrossRefGoogle ScholarPubMed
50 Greenberg, HS, Kim, JH, Posner, JB. Epidural spinal cord compression from metastatic tumor: results with a new treatment protocol. Ann Neurol. 1980;8(4):361–6.Google Scholar
51 Sørensen, PS, Børgesen, SE, Rohde, K, et al. Metastatic epidural spinal cord compression. Results of treatment and survival. Cancer. 1990;65(7):1502–8.Google Scholar
52 Young, RF, Post, EM, King, GA. Treatment of spinal epidural metastases: randomized prospective comparison of laminectomy and radiotherapy. J Neurosurg. 1980;53(6):741–8.Google Scholar
53 Siegal, T, Siegal, T. Surgical decompression of anterior and posterior malignant epidural tumors compressing the spinal cord: a prospective study. Neurosurgery. 1985;17(3):424–32.Google Scholar
54 Harrington, KD. Anterior decompression and stabilization of the spine as a treatment for vertebral collapse and spinal cord compression from metastatic malignancy. Clin Orthop Relat Res. 1988;233:177–97.CrossRefGoogle Scholar
55 Sundaresan, N, Digiacinto, GV, Hughes, JEO, Cafferty, M, Vallejo, A. Treatment of neoplastic spinal cord compression: results of a prospective study. Neurosurgery. 1991;29(5):645–50.Google Scholar
56 Patchell, RA, Tibbs, PA, Regine, WF, et al. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet. 2005; 366(9486):643–8.Google Scholar
57 Ghogawala, Z, Mansfield, FL, Borges, LF. Spinal radiation before surgical decompression adversely affects outcome of surgery for symptomatic metastatic spinal cord decompression. Spine. 2001; 26(7):818–24.Google Scholar
58 McPhee, IB, Williams, RP, Swanson, CE. Factors influencing wound healing after surgery for metastatic disease of the spine. Spine. 1998;23(6):726–32.Google Scholar
59 Wise, JJ, Fischgrund, JS, Herkowitz, HN, Montgomery, D, Kurtz, LT. Complication, survival rates, and risk factors of surgery for metastatic disease of the spine. Spine. 1999;24(18):1943–51.Google Scholar
60 Arguello, F, Baggs, RB, Duerst, RE, Johnstone, L, McQueen, K, Frantz, CN. Pathogenesis of vertebral metastasis and epidural spinal cord compression. Cancer. 1990;65(1):98–106.Google Scholar
61 Maranzano, E, Latini, P. Effectiveness of radiation therapy without surgery in metastatic spinal cord compression: final results from a prospective trial. Int J Radiat Oncol Biol Phys. 1995;32(4): 959–67.Google Scholar
62 Daw, HA, Markman, M. Epidural spinal cord compression in cancer patients: diagnosis and management. Cleve Clin J Med. 2000;67(7):501–4.Google Scholar
63 Sundaresan, N, Rothman, A, Manhart, K, Kelliher, K. Surgery for solitary metastases of the spine: rationale and results of treatment. Spine. 2002;27(16):1802–6.CrossRefGoogle ScholarPubMed
64 Nguyen, QN, Shiu, AS, Rhines, LD, et al. Management of spinal metastases from renal cell carcinoma using stereotactic body radiotherapy. Int J Radiat Oncol Biol Phys. 2010;76(4):1185–92. Epub 2009 Jul 23.CrossRefGoogle ScholarPubMed
65 Pascal-Moussellard, H, Broc, G, Pointillart, V, Siméon, F, Vital, JM, Sénégas, J. Complications of vertebral metastasis surgery. Eur Spine J. 1998;7(6):438–44.Google Scholar
66 Krishnaney, AA, Steinmetz, MP, Benzel, EC. Biomechanics of metastatic spine cancer. Neurosurg Clin N Am. 2004;15(4): 375–80.Google Scholar
67 Sundaresan, N, Steinberger, AA, Moore, F, et al. Indications and results of combined anterior-posterior approaches for spine tumor surgery. J Neurosurg. 1996;85(3):438–46.Google Scholar