What it is
The spine is the most common site for cancer to spread to bone. Deposits can weaken the vertebra to the point of fracture, or grow into the canal and compress the spinal cord. Breast, lung, prostate, kidney and thyroid cancers and myeloma account for the majority.
The aims of treatment are usually pain control, preserving the ability to walk, and maintaining stability — alongside, and in service of, the oncological plan.
Symptoms
- Progressive back pain, characteristically worse at night and at rest
- New pain in someone with a known cancer history, which should always be investigated
- Weakness or numbness in the legs; difficulty walking
- Bladder or bowel changes, which require emergency assessment
How it is diagnosed
MRI of the whole spine, because deposits are frequently at more than one level. CT assesses bone destruction and stability. Staging imaging and, where the primary is unknown, a biopsy. Scoring systems for stability and for prognosis help structure the decision, though they do not make it.
Non-surgical treatment
Radiotherapy is highly effective for pain from many deposits. Systemic treatment, bone- modifying agents, bracing and pain management all play a part. Many people are managed without surgery.
When surgery is considered
Spinal cord compression, mechanical instability, or pain from a structural problem that radiotherapy will not address. Options run from cement stabilization through to decompression and instrumented stabilization. Dr. Long works within the oncology team, and the right operation is the one that fits the rest of the plan — often a smaller one than the imaging alone would suggest.
How Dr. Long sees these patients
Most often through the hospitals where he takes emergency call, rather than as a planned referral. Cord compression and an unstable vertebra are problems that arrive at night and cannot wait for a clinic appointment, and he operates on them when that is what the situation needs.
Planned metastatic surgery is a different matter and usually belongs with the oncology team that already knows the case. If you are under cancer care and the spine has become the problem, the first call is to that team; they will say whether a spine surgeon is needed and when.