Spinal Metastasis
Epidemiology
80% cancer patients have spinal metastasis at autopsy
Spine is number one site for bony metastasis (50%)
Cause
Hexagon: PBBLTK
Prostate Breast
80% cancer patients have spinal metastasis at autopsy
Spine is number one site for bony metastasis (50%)
Hexagon: PBBLTK
Prostate Breast
M:F =2:1
30-40 years
20% diabetic
50-80% identifiable source
Lumbar (50%) > Thoracic > Cervical (<10%)
1. Haematogenous
- arterial rather than venous
Risk factors
- UTI (40% of all cases)
- IVDU
- elderly
Pus collection in the epidural space
Usually haemotogenous seeding
Very rare
- 37 / 1 000 000 patients with LBP
- 1 /10 000 admissions
- most common in old men
Average age 68 years
3/4 males
Rare in paediatrics
Clinical diagnosis
- based on a sclerotomal distribution of motor &/or sensory symptoms or signs
Caused by impingement of exiting nerve roots
- HNP
- zygo-apophyseal / facet joint hypertrophy
- neuro-central joint hypertrophy
May be acute or chronic
M>F
Peak age 50-54
C7 > C6
Spinal cord dysfunction
- extrinsic compression of the cord or its vascular supply
- caused by degenerative disease of spine
Most common spinal cord dysfunction in patients > 55 years old
C5/6 commonest level
Cervical spondylosis
- chronic disc degeneration & associated facet arthropathy
Cervical myelopathy
- spinal cord dysfunction
- secondary to extrinsic compression of cord or its vascular supply
Cervical radiculopathy
- sclerotomal distribution of motor &/or sensory symptoms or signs
- due to compression of nerve root
Neck involved in 86%
- second most common site after hands and feet
- closely associated with MCPJ subluxation
Males / Steroid use / Seropositivity Nodules / Severe long standing disease
Atlanto-axial subluxation
Subaxial subluxation
Superior migration ondontoid