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Khối u di căn của các cột sống: Chẩn đoán và điều trị

Bệnh di căn cột sống xảy ra ở 70% bệnh nhân ung thư phổ biến và có thể dẫn đến sụp đổ xương cột sống, sự bất ổn định cột sống, và làm tổn hại thần kinh tiến bộ. Ngày nay, hình ảnh cộng hưởng từ là phương tiện hiệu quả nhất để phân biệt lành tính | Metastatic Tumors of the Spine Diagnosis and Treatment Kevin D. Harrington MD Abstract Metastatic disease of the spine occurs in as many as 70 of patients with disseminated cancer and may result in vertebral collapse spinal instability and progressive neurologic compromise. Today magnetic resonance imaging is the most effective means of differentiating benign from malignant causation of vertebral collapse based on the imaging patterns and extent of marrow ablation. The more rapid the onset of the neurologic deficit the worse the prognosis for recovery no matter what treatment is instituted. The majority of vertebral lesions requiring decompression and stabilization emanate from the vertebral body and are best managed by anterior decompression and stabilization alone. With posterior element destruction spinal subluxation through the involved segment or involvement of the lumbar spine a combination of both anterior and posterior stabilization is required. The author s preference is to perform anterior vertebral replacement with methylmethacrylate incorporating a Knodt distraction rod. This construct affords instantaneous stability that is not adversely affected by postoperative irradiation. Many devices can provide adequate posterior stabilization but the author prefers to use Luque rods with sublaminar wire fixation. In a series of 77patients with major neurologic compromise treated with this technique 62 showed improvement by at least two Frankel grades compared with fewer than 5 who improved after laminectomy decompression with or without irradiation. Nineteen of the 77 patients remained alive more than 4years postoperatively. J Am Acad Orthop Surg 1993 1 76-86 The spine is the most common site for skeletal metastases irrespective of the primary tumor involved. The vertebral body typically is affected first because of its rich blood supply and sinusoidal vascular distribution. However the initial radiographic finding often is destruction of a less well .