![]() ![]() ![]() A multidisciplinary approach and the application of the proposed algorithm is of paramount importance to optimize the outcomes of these patients.Ībout 60% of secondary tumor localizations involves the spinal column ( 1). Treatment strategies should be planned comprehensively. Early surgical or radiation therapy treatment gives the best hope for preventing the worsening, or even improving, the deficits.Ĭonclusions: Metastatic spinal cord compression can cause neurological deficits compromising quality of life. The awareness of the alert symptoms and the application of an integrated paradigm consent to frame the patients with spinal cord compression, obtaining the benefits of a homogeneous step-by-step diagnostic and therapeutic path. Even when there is no previous cancer history, the patient’s pain characteristics and clinical signs must be interpreted to yield the correct diagnosis of vertebral metastasis with incipient or current spinal cord compression. Fifteen were operated on, 10 of these programmed and 5 in emergency.ĭiscussion: Patients with a history of malignancy can present to the ER or to the oncology department with symptoms that must be correctly framed in the context of a metastatic involvement. The level was thoracic in 21 cases, lumbar in 4 cases, cervical in 1 case, sacral in 1 case. Among these, 27 were admitted due to rapid progression of symptoms, neurological deficits and/or spine instability signs. Fifty-three patients presented with actual or incipient spinal cord compression. Results: In 2021, the Spine and Spinal Cord Surgery department evaluated 257 patients with vertebral metastasis. The oncologist gets involved after surgery for systemic therapy. If indicated, surgical treatment should precede radiation therapy. From the MRI outcome, the spine surgeon and the radiation oncologist consult each other to define further therapeutic alternatives. The spine surgeon takes charge of the patient and, on the base of the anamnestic data and neurological examination, defines the appropriate timing for magnetic resonance imaging (MRI) in collaboration with the neuroradiologist. Once the suspicion is confirmed, the following steps of the flow-chart must be triggered. The ER physician or the oncologist intercept the patient with symptoms and signs of a metastatic spinal cord compression. ![]() ![]() A spine surgeon, an emergency room (ER) physician, a neuroradiologist, a radiation oncologist, and an oncologist form the multidisciplinary team. Materials and Methods: The algorithm is born from the experience of a primary care center. The purpose of this paper is to define a diagnostic-therapeutic path for patients with vertebral metastases and from this path to build an algorithm to reduce the devastating consequences of spinal cord compression. Introduction: The morbidity associated with metastatic spinal disease is significant because of spinal cord and/or nerve root compression. 6Clinica di Ematologia, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Universitario “Santa Maria della Misericordia” di Udine, Udine, Italy.5SOC Pronto Soccorso e Medicina d’Urgenza, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Universitario “Santa Maria della Misericordia” di Udine, Udine, Italy.4SOC Neuroradiologia, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Universitario “Santa Maria della Misericordia” di Udine, Udine, Italy.3SOC Oncologia, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Universitario “Santa Maria della Misericordia” di Udine, Udine, Italy.2SOC Radioterapia, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Universitario “Santa Maria della Misericordia” di Udine, Udine, Italy.1SOC Chirurgia Vertebro-Midollare, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Universitario “Santa Maria della Misericordia” di Udine, Udine, Italy.Rossella Rispoli 1, Chiara Reverberi 2, Giada Targato 3, Serena D’Agostini 4, Gianpiero Fasola 3, Marco Trovò 2, Mario Calci 5, Renato Fanin 6 and Barbara Cappelletto 1* ![]()
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