Is surgery still worthwhile for spinal bone metastasis?

This is the 2676th article of Da Yi Xiao Hu

In today's society, the incidence of malignant tumors is getting higher and higher. It is composed of a group of uncontrolled and rapidly growing cells and has become the "number one killer" threatening human life. There are more than 3 million new cases of tumors in my country every year. With the development of tumor surgical technology and the widespread application of various anti-tumor drugs such as targeted drugs and advanced stereotactic radiotherapy (SRS) and other radiotherapy technologies, the survival period of tumor patients with tumors has been significantly extended, and the chance of spinal bone metastasis has also increased greatly. Almost all malignant tumors may have spinal bone metastasis, which seriously affects the quality of life and life expectancy of patients. 75% of patients with spinal metastasis are secondary to common malignant tumors such as breast cancer, lung cancer, kidney cancer, prostate cancer, and thyroid cancer. Once the tumor metastasizes to the spine, the public generally believes that it is already in the late stage of the disease; many doctors also believe that spinal tumor surgery is difficult and risky, and is a "minefield" in the medical field; therefore, many people think that "there is no hope and it cannot be cured", and the value of surgery has been lost. However, it is this negative and backward concept that has seriously affected the active treatment of spinal metastatic tumors, resulting in late treatment, poor results, and patient suffering. Therefore, we need to correctly understand and choose the treatment methods for spinal metastatic tumors to maximize the patient's quality of life and prolong the patient's life.

So, why should we actively treat or even operate on the tumor when it has metastasized to the spine? What is the value? First, if spinal metastatic tumors are not actively treated and allowed to develop, they can easily cause paralysis. Then the patient can only stay in bed and cannot take care of himself, and his body functions will decline rapidly. Not only will his quality of life be extremely low, but the effects of radiotherapy, chemotherapy, and biological treatment will also be far less than expected. Second, spinal metastatic tumors often cause severe pain. Malignant tumors themselves will produce cancer pain, and if they invade the nerves, the pain will become more severe. In clinical work, doctors often see patients with spinal metastatic tumors who are tortured by severe pain and cannot sleep at night or sit or lie down. If effective tumor resection is performed at this time, or even just palliative decompression surgery, it will greatly relieve the pain and provide conditions for subsequent treatment. Third, if some tumors with a good prognosis are relatively limited, such as breast cancer and prostate cancer, the entire spine can be removed en bloc, so that the patient can achieve a tumor-free state and live like a normal person.

So, for spinal bone metastasis of tumors, is surgery necessary or what kind of surgical treatment is neither passive nor excessive? In the past decade, with the full spine resection, the most difficult and risky surgery in spinal surgery, the risk of surgery has been effectively reduced through the continuous exploration and improvement of spinal tumor surgery teams including the Department of Orthopedic Spine Surgery of Zhongshan Hospital Affiliated to Fudan University. This procedure has been carried out in the spine surgery departments of more and more large hospitals, benefiting many patients. On this basis, five years ago, Zhongshan Hospital Affiliated to Fudan University began to use multidisciplinary collaboration (MDT) to comprehensively diagnose and treat spinal metastases. According to the patient's symptoms, the malignancy and classification of the primary tumor, life expectancy and the patient's general condition, a scientific and refined comprehensive treatment plan of internal, external, interventional, radiotherapy and other disciplines was formulated. Through targeted evaluation and judgment, patients who need surgical treatment can be individually selected in stages, such as minimally invasive vertebroplasty, minimally invasive percutaneous fixation, minimally invasive spinal canal decompression percutaneous fixation, spinal canal decompression tumor spinal nerve separation, tumor bulk resection, and complete spine resection, to reduce the compression of the tumor on the spinal nerves, relieve pain, reconstruct spinal stability, preserve and restore nerve function, and enable subsequent radiotherapy, chemotherapy, and biological therapy to be carried out more quickly and effectively, thereby improving the patient's quality of life and indirectly prolonging their lives. At present, the concept of comprehensive diagnosis and treatment of spinal tumors by MDT and refined step-by-step surgery has been promoted by spinal tumor teams in more and more large hospitals.

To sum up, we should understand that when a tumor metastasizes to the spinal bones, there is no need to be pessimistic. The correct way is to find a suitable solution and perform surgery when necessary.

Author's unit: Institute of Medical Science Popularization, Fudan University

Department of Orthopaedics and Spine Surgery, Zhongshan Hospital, Fudan University

Author: Lin Hong and Chen Weixin

Reviewer: Dong Jian