It is rare before the age of 35.
The primary is most often situated in:
- less frequently in the uterus, stomach, kidney, or elsewhere (Stark et al. 1982).
Although the vertebral metastasis may be blood borne, the spine is sometimes involved at the same segmental level as the primary growth, which in such cases may reach it via the perineurial lymphatics.
The carcinomatous deposits erode the spongy portions of the vertebral bodies, which finally collapse. The spinal cord may be compressed as a result of the spinal deformity or by an extradural extension of the growth. Usually the spinal roots are compressed earlier than the cord itself so that root and back pain may be present for some time before vertebral collapse gives acute cord compression.
When multiple vertebrae are involved, treatment may only be palliative. Chemotherapy appropriate to the particular form of cancer will sometimes be indicated, e.g. tamoxifen for breast carcinoma.
In many cases of acute compression at a single level, emergency laminectomy and decompression is indicated in order to relieve pressure and to obtain a surgical biopsy of the tumour as a preliminary to radiotherapy and chemotherapy.
Decompression by an anterior approach is sometimes used.
The question as to whether the lesion should be irradiated depends upon the general condition of the patient and the situation and prognosis of the primary lesion, when known. Many patients have relief of pain as a result and, in some, cord compression is relieved; hence this treatment is usually indicated if the lesion is radiosensitive and unless the patient is in extremis as a result of the primary growth or metastases elsewhere. Powerful analgesics and, in selected cases, surgical methods of pain relief (cordotomy, stereotactic thalamotomy) may rarely be required.
- Skeletal metastases