Management of Metastases to the Spine and Sacrum

The incidence of bone metastatic deposit from carcinoma is second only to pulmonary and hepatic metastases. The most frequently affected segment of the skeleton is the vertebral column. Refinement of the protocols for treating tumour patients has led to a progressive improvement in the prognosis for many tumour histotypes in terms of increase of life expectancy. The choice of the most appropriate treatment is of crucial importance for the patient who may be severely disabled by the presence of untreated spinal metastases. It is commonly accepted that bone metastases are an expression of a systemic disease, and therefore require multi-disciplinary treatment, integrating radiotherapy (RT), chemotherapy (CHT) and surgery. The most appropriate treatment for patients with metastatic disease of the vertebral column is controversial. Appropriate surgical treatment of bone metastases and tumours in general has now become an integral part of the correct approach to the tumour patient. The evolution of anaesthetic techniques now allows more aggressive treatment of some patients with spinal and sacral metastases. These procedures can dramatically improve the patient’s quality of life and may prolong the patient’s life expectancy by preventing complications related to paralysis.