Spinal metastases clinical features [Neurosurgery Wiki]

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====== Spinal metastases clinical features ======


[[Spinal Metastases]] are a common source of severe [[pain]] in [[cancer]] patients. The secondary effects of spinal metastases include pain, [[bone fracture]]s, hypercalcemia, and neurological deficits. As the disease progresses, pain severity can increase until it becomes refractory to medical treatments and leads to a decreased quality of life for patients. A key obstacle in the study of pain-induced spinal cancer is the lack of reliable and reproducible spine cancer animal models
((Sarabia-Estrada R, Ruiz-Valls A, Guerrero-Cazares H, Ampuero AM,
Jimenez-Estrada I, De Silva S, Bernhardt LJ, Goodwin CR, Ahmed AK, Li Y, Phillips
NA, Gokaslan ZL, Quiñones-Hinojosa A, Sciubba DM. Metastatic human breast cancer 
to the spine produces mechanical hyperalgesia and gait deficits in rodents. Spine
J. 2017 Apr 13. pii: S1529-9430(17)30143-2. doi: 10.1016/j.spinee.2017.04.009.
[Epub ahead of print] PubMed PMID: 28412561.
)).
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Apart from chronic and increasing pain, spinal metastases lead to neurological deficits due to destruction of the vertebral body and subsequent epidural growth expansion. 

Back pain is the earliest and most common symptom of spinal epidural metastases. [[Back pain]] is present in more than 95% of patients at diagnosis
((Cole JS, Patchell RA. Metastatic epidural spinal cord compression. Lancet Neurol. 2008;7:459–66.)).

Spinal epidural metastases associated back pain can takes several forms. Localized pain to the region of the spine affected by the metastases is usually the first symptom; typically, the pain progressively increases in intensity over time. This pain is caused when the bone marrow metastases extends to stretch the periosteum or invades soft tissues. Radicular pain due to compression or invasion of the nerve roots is commonly present in patients who develop MESCC. The pain is frequently unilateral with cervical or lumbosacral spine involvement or bilateral with thoracic spine involvement. Mechanical back pain is associated with spinal instability caused by vertebral body collapse and is relatively uncommon; it is made worse by movement and partially relieved by rest
((Mavrogenis AF, Pneumaticos S, Sapkas GS, Papagelopoulos PJ. Metastatic epidural spinal cord compression. Orthopedics. 2009;32:431–9.)).