Treatment of metastatic spine disease Journal Article
| Authors: | Elder, J. B.; Lis, E.; Yamada, Y.; Bilsky, M. H. |
| Article Title: | Treatment of metastatic spine disease |
| Abstract: | The NOMS decision framework can be applied to metastatic spinal tumors to aid in decision-making regarding the best treatment, radiation therapy or surgery. The fundamental decisions in NOMS are neurologic, oncologic, mechanical instability and systemic disease and medical co-morbidities. NOMS allows for the integration of new technologies, such as stereotactic radiosurgery and percutaneous cement augmentation. This review article applies NOMS to decision-making for metastatic spinal tumors based on the current literature. Based on neurologic and oncologic assessments, patients with radiosensitive tumors, regardless of the degree of spinal cord compression or severity of myelopathy, can be treated with conventional external beam radiation. Radioresistant tumors without spinal cord compression are best treated with high-dose stereotactic radiosurgery, and radioresistant tumors with high-grade spinal cord compression should be operated followed by stereotactic radiosurgery. Mechanical instability is a separate assessment. Based on clinical and radiographic criteria, gross spinal instability requires an open operation while axial load pain in the absence of gross instability may be treated with percutaneous cement augmentation. All treatment is based on what the patient can tolerate from a medical and systemic disease standpoint. The evolution of new technology continues to advance the treatment of metastatic spinal tumors necessitating frequent updates on practice recommendations that can be integrated through the NOMS framework. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins. |
| Keywords: | review; clinical practice; clinical assessment; oncology; patient care; disease severity; spinal cord compression; spinal cord tumor; comorbidity; radiosensitivity; medical literature; stereotactic radiosurgery; external beam radiotherapy; decision making; spine metastasis; spinal cord disease; metastatic spine tumor; spidural spinal cord compression; spinal instability; spine stereotactic radiosurgery; spine instability |
| Journal Title: | Current Orthopaedic Practice |
| Volume: | 21 |
| ISSN: | 1940-7041 |
| Publisher: | Wolters Kluwer Health | Lippincott Williams & Wilkins |
| Date Published: | 2010-01-01 |
| Start Page: | 348 |
| End Page: | 355 |
| Language: | English |
| DOI: | 10.1097/BCO.0b013e3181e363e3 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Export Date: 20 April 2011" - "Source: Scopus" |
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