Back pain, which can precede the appearance of other signs indicating a spinal metastasis by months or even years, is the single most important component of the clinical presentation [1] [2]. Studies discriminate two types of pain [1] [2]:

• Tumor-related pain - Pain developing during the night or early morning in a localized fashion is thought to occur as a result of the tumor's expanding effect in the spine, causing increased pressure [1] [2]. Although it may increase in severity, it resolves with activity and becomes absent during the day [1] [2]:
• Mechanical pain - Pathological compression of the spine and possible fractures that develop due to the presence of the tumor inevitably leads to pain that becomes aggravated by activity or in the setting of higher load on the spine (for example, during walking or standing) [1] [2]. Another distinguishing feature of mechanical pain is that it is not responsive to steroid therapy, unlike tumor-related pain [1].

In addition to back pain, neurological findings are the second important element of spinal metastases [1] [2]. Radiculopathy is perhaps the predominant type of neurological deficit, manifesting as weakness or pain in the upper or lower extremities (depending on the level of the lesion) [1] [2]. Band-like pain is reported in the case of a thoracic radiculopathy, whereas hyperreflexia, a positive Babinski sign, and deficits of the spinothalamic tract functions (pain/temperature/sensation) are hallmarks of a myelopathy [1] [2]. If the tumor is located in the sacral region and affects the conus medularis, autonomic dysfunction (poor sphincter and bladder control) can be noted [1]. Although rare, an asymptomatic clinical course is possible [1] [2].

• Pathologist

  RESULTS: It is important that pathologists and surgeons recognize that spindle cell type MPNST may arise in benign schwannoma, as this recognition aids in assessment of patients with schwannoma and contributes to the pathologist making a more precise [ncbi.nlm.nih.gov]

  Our physical and occupational therapists and speech pathologists can help you strengthen your muscles, improve your mobility, speak more clearly, or learn easier ways to perform everyday tasks. [dukehealth.org]

  A pathologist then views this sample under a microscope to determine what type of cells make up the tumor. The type of biopsy used depends on where the tumor is located. [oncolink.org]

  During a biopsy, they’ll remove a small amount of the tumor and send it to a pathologist for a thorough examination. Treatment of metastases often depends on the location and the source tumor cells. [healthline.com]

• Constitutional Symptom

  In addition, patients may have constitutional symptoms such as low-grade fever, night sweats, fatigue, malaise, and/or loss of appetite, among others. Physical Findings The physical findings for patients with a spine tumor are limited. [uscspine.com]

  Systemic or constitutional symptoms tend to be more common with malignant or metastatic disease than in benign lesions. [patient.info]

• Lower Extremity Pain

  Case report This 59-year-old woman presented with a 2-month history of low back pain and right lower extremity pain. [nature.com]

• Inguinal Pain

  By post-operative day 3, the patient had marked improvement in symptoms, with pain decreased to 1 out of 10 on the VAS in his lower back, although he had persistent inguinal pain. [iolearning.com]

• Back Pain

  A 41-year-old male presented with a 1-month history of severe back pain radiating to both legs. The patient underwent a right nephrectomy for treatment of a RCC 1-year before admission. [ncbi.nlm.nih.gov]

  Hence, this entity must be considered in the diagnostic workup of such patients, particularly in the presence of back pain. [symptoma.com]

• Low Back Pain

  MATERIAL AND METHODS: A 79-year-old male patient presented with low back pain since 1 year and severe sacral pain irradiating to the left leg, paraparesis, urinary dysfunction and leg weakness since one week. [ncbi.nlm.nih.gov]

• Spine Pain

  The type of pain can provide important information about the tumor. Pain mainly when you sit or stand usually means that the tumor is causing weakness or instability in the bones of your spine. [mskcc.org]

  The patient underwent left lateral temporal bone resection, which provided him with good pain relief. One month later, the patient returned with numbness and weakness of his right arm and posterior low cervical spine pain. [jamanetwork.com]

• Leg Pain

  Some common signs of spinal tumors may include: Pain (back and/or neck pain, arm and/or leg pain) Muscle weakness or numbness in the arms or legs Difficulty walking General loss of sensation Difficulty with urination (incontinence) Change in bowel habits [cancercenter.com]

• Neurologic Manifestation

  Constans JPDe Divitiis EDonzelli RSpaziante RMeder JFHaye C Spinal metastases with neurologic manifestations: review of 600 cases. J Neurosurg.1983;59:111-118.Google Scholar 13. Hammerburg KW Surgical treatment of metastatic spine disease. [jamanetwork.com]

  Constans JP, de Divitiis E, Donzelli R et al. (1983) Spinal metastases with neurological manifestations. Review of 600 cases. J Neurosurg 59: 111–118 PubMed Google Scholar 22. [link.springer.com]

  Constans JP, Divitiis ED, Donzelli R, et al: Spinal metastases with neurological manifestations: Review of 600 cases. J Neurosurg 59:111-118, 1983. 14. [cancernetwork.com]

• Hyperreflexia

  Band-like pain is reported in the case of a thoracic radiculopathy, whereas hyperreflexia, a positive Babinski sign, and deficits of the spinothalamic tract functions (pain/temperature/sensation) are hallmarks of a myelopathy. [symptoma.com]

  Myelopathy begins as hyperreflexia, a Babinski reflex and clonus, but progresses to weakness, proprioceptive sensory loss, and loss of pain and temperature below the level of the spinal cord compression. [theoncologist.onlinelibrary.wiley.com]

The spine is the most common site of skeletal tumor spread and it is estimated that up to 70% of individuals who suffer from a malignant disease (the breast, prostate, thyroid, kidney, pancreas, and lung all spread to the musculoskeletal system) will eventually develop a spinal metastasis [3] [4]. Hence, this entity must be considered in the diagnostic workup of such patients, particularly in the presence of back pain. The physician is obliged to perform a detailed history, during which all important symptoms should be covered, as well as their course and progression, whereas the physical examination provides crucial findings that aid in localizing the etiology. Still, to confirm the diagnosis and establish the exact level of metastatic tumor spread, imaging studies need to be employed. Plain radiography is commonly used as the first-line study in the assessment of spinal-related pathologies, but for a tumor to be visualized on X-rays, it needs to be at least 1 cm in size and cause significant vertebral damage (destruction of 30-50% of the vertebral body) [1] [2] [3] [4] [5]. For this reason, advanced studies are often required. CT and myelography were very useful until the introduction of MRI, one of the most important diagnostic modalities when it comes to spinal metastasis [1] [2] [3] [4] [5] [6]. Bone scanning (99mTc) is a great study that allows detection of tumors and inflammation throughout the entire skeleton, not only the spine, and is frequently used in combination with MRI and other studies [1] [4] [5] [6]. If an opportunity for a biopsy exists, an open biopsy is the favored approach [5] [7].

Preliminary report of new antitumor treatment. To evaluate the effectiveness of electrochemotherapy as a novel treatment of spinal metastasis. [ncbi.nlm.nih.gov]

Further analysis of factors predicting prognosis should be conducted with respect to each type of primary tumor to help accurately predict prognosis. [ncbi.nlm.nih.gov]

Scoring system for prediction of metastatic spine tumor prognosis. World J Orthop 2014;5:262–271. Crossref, Medline, Google Scholar 16. Schiff D, O’Neill BP, Suman VJ. [online.boneandjoint.org.uk]

The physician is obliged to perform a detailed history, during which all important symptoms should be covered, as well as their course and progression, whereas the physical examination provides crucial findings that aid in localizing the etiology. [symptoma.com]

Etiology Most common spine metastasis involving primary metastasis originate from the following tumors in descending order: breast (21%), lung (19%), prostate (7.5%), renal (5%), gastrointestinal (4.5%), and thyroid (2.5%). [ncbi.nlm.nih.gov]

STUDY DESIGN/SETTING: This was an epidemiologic study using national administrative data from the Nationwide Inpatient Sample (NIS) database. [ncbi.nlm.nih.gov]

Methods - Epidemiological and biological data, as well as treatment protocols and secondary localization were analyzed for 650 consecutive patients diagnosed with MM from January 2006 to January 2017. [ibrain.univ-tours.fr]

Epidemiology 80% cancer patients have spinal metastasis at autopsy Spine is number one site for bony metastasis (50%) Cause Hexagon: PBBLTK Prostate Breast Bronchus MM Lymphoma Bowel Renal Thyroid NHx 20% of develop cord compression 30% survive >12/12 [52.62.202.235]

Overview of the epidemiology, clinical presentation, diagnosis, and management of adult patients with bone metastasis. http://www.uptodate.com/home. Accessed Jan. 2, 2015. Longo DL, et al. Harrison's Principles of Internal Medicine. 18th ed. [mayoclinic.org]

To describe the diagnosis, pathophysiology, and treatment of a papillary renal cell carcinoma that developed an intradural spinal mass with cauda equina infiltration. [ncbi.nlm.nih.gov]

Although myelitis can be prevented largely by instituting dose constraints, it is less clear what the fracture risk of a structurally compromised vertebra is, and what should be done in terms of stabilization and dosimetry to mitigate this risk. [ncbi.nlm.nih.gov]

The brain is often and for good reason protected by a barrier called the blood brain barrier (BBB) that normally serves to prevent toxic substances from entering. [dukecancerinstitute.org]

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