Metastatic Tumor of the Spine

Park, Byeong Mun; Hahn, Soo Bong; Kim, Nam Hyun; Lee, Jae Chul

Abstract

The spine is the most common site of metastatic cancer in the skeletal system. Managment of the lesion site due to the relation of the spinal cord or nerve root and post-operative treatment present coplicated and difficult problems. One hundred and ninety-three cases of metastatic cancer of the spine were seen and treated during the 5 year period from January 1981 to December 1985 in the Department of Orthopedic Surgery, Severance Hospital Yonsei University, College of Medicine in Seoul, Korea. This study was based on the clinical symtoms, radiological studies, laboratory studies, and tissue pathology of selected cases. Most of cases were treated by chemotherapy, radiation therapy, and hormonal therapy in selected terminal cases. In cases of intractable pain and neurological deficit, surgical intervention is advocated for relief of pain and to improve nursing care and daily activity. Unfortunately in Korea most patients and families refuse surgical intervention, the main reason being that surgery can not cure the disease itself. The results of the study lead us to conclude that; The incidende of spinal metastasis was 31.8% of the metastatic lesions of all skeletal systems, and was almost equally distributed in males and females l. 14: l. The primary site of the tumor was in decreasing order lung (25.9%), breast(9.8%), cervix of the uterus(6.7%), stomach(5.7%), liver(5.3%), kidney(3.7%), thyroid(3.7%), prostate(2.6%), bladder(2.6%), rectum(2.0%), ovary(1.0%), pancreas(1.0%), skin(1.0%), colon(0.5%), larynx(0.5%), and unknown origins (27.5 %). The peak age of the patient was the 7th decade in males and the 6th decade in females. The prominent clinical symtom was diffuse back pain (79.0%) which was characteristically worse in a resting position especially at night. The most significant laboratory finding was an elevated serum alkaline phosphatase in 28% of the cases. The predilection site of metastasis was the thoraco-lumbar junction. Diagnostically a whole body bone scan was more sensitive than a plain film.