Spine metastasis

Wednesday, 15 February 2023 16:38

- Whole MRI spine: for bone metastasis (neurological

involvement)
- Sagittal: for screening
- CT may be needed if want assess bone (done if surgery
for architecture)
- IF MRI CI: CT myelogram (contrast injected in dura)

MRI spine: for bone metastasis

- T2W: Since CSF hyperintense (T1: Fat bright)
- Iso/ hypointense lesion at spinal corrd invading vertebral body
- Kyphosis of T6 (vertebral body collapse)
- Hyperintense signal at T8/9 posterior vertebral body
- CA often affect pedicle
- Owl-wink sign: loss of pedicle
- Heterogenous signal at T10 vertebral body
- Involvement of posterior body

MX: spine neoplasm

- Pain control
- NSAID: X given since dexa used (both have risk of GI
bleed
 MX: spine neoplasm
- Pain control
- NSAID: X given since dexa used (both have risk of GI bleed
- GABA/ opiate
- Terminal: morphin drip
- Cord compression (by bone met)
- Monitor for ROU or sphincter incompetence: foley if needed
- Decreased mobility: aware bed sore & may thrombolytics for DVT
• Steroids (dexmethasone): relieve swelling/ inflammation caused by
NEOPLASM spinal cord compression
○ X used if trauma
○ Given with PPI: since risk of GI bleed
• RT/ Chemotherapy
• Surgical decompression: Anterior radical debridement (whole spine
MRI) & spine stabilization
○ Indications for surgery: NOMS neurology, oncology, mechanical,
systemic
§ Neurological: sphincter incompetence and acute
deterioration
§ Oncology: responsive to RT, chemotherapy
§ Mechanical: if very unstable (whole vertebral body
involved)/ Involve cervical spine
□ SINS: Spinal instability neoplastic score
§ Systemic: comorbid (can stand GA)