Imaging characteristic analysis of metastatic spine lesions from breast, prostate, lung, and renal cell carcinomas for surgical planning: Osteolytic versus osteoblastic.
BACKGROUND
Surgeons treating metastatic spine disease can use computed tomography (CT) imaging to determine whether lesions are osteolytic, osteoblastic, or mixed. This enables treatment that considers the structural integrity of the vertebral body (VB), which is impaired with lytic lesions but not blastic lesions. The authors analyzed CT imaging characteristics of spine metastasis from breast, lung, prostate, and renal cell carcinomas (RCCs) to determine the metastasis patterns of each of these common tumors.


METHODS
The authors identified patients with metastatic spine disease treated during a 3-year period. Variables studied included age, sex, and cancer type. Lesions from breast, lung, prostate, and RCC primary lesions were selected for imaging analysis.


RESULTS
Sixty-six patients were identified: 17 had breast metastasis, 14 prostate, 18 lung, and 17 RCC. Breast cancer metastasis involved 33% of VBs with 56%, 20%, and 24% osteolytic, osteoblastic, and mixed, respectively. Prostate cancer metastasis involved 35% of VBs with 14%, 62%, and 24% osteolytic, osteoblastic, and mixed, respectively. Lung cancer metastasis involved 13% of VBs with 64%, 33%, and 3% osteolytic, osteoblastic, and mixed, respectively. RCC metastasis involved 11% of VBs with 91%, 7%, and 2% osteolytic, osteoblastic, and mixed lesions, respectively.


CONCLUSIONS
To improve surgical planning, we advocate the use of CT prior to surgery to evaluate whether spine metastases are osteolytic or osteoblastic. In cases of osteolytic lesions, the concern is of segmental instability requiring reconstruction and the risk for screw pull out should instrumentation be considered. In cases of osteoblastic lesions, surgeons should consider debulking dense bone.
Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, USA.
Justin A
JA
Reddington
Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, USA.
Gustavo A
GA
Mendez
Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Oregon, USA; Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA.
Alex
A
Ching
Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA; Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon, USA.
Charlotte Dai
CD
Kubicky
Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA; Semmes-Murphey Neurologic and Spine Institute, Memphis, TN, USA.
Paul
P
Klimo
Rebound Orthopedics and Neurosurgery, Vancouver, WA, USA.
Brian T
BT
Ragel
Computed tomography; osteoblastic; osteolytic; spine metastasis; surgery