bims-rebome Biomed News
on Rehabilitation of bone metastases
Issue of 2025–12–21
two papers selected by
Alberto Selvanetti, Azienda Ospedaliera San Giovanni Addolorata
  1. Comprehensive guide to the diagnosis, management, and treatment of metastatic spinal cord compression syndrome.
  2. Navigating the Surgical Dilemma in Metastatic Spine Disease: Does Age Influence Treatment Strategy and Outcomes?
  1. Surg Oncol. 2025 Dec 13. pii: S0960-7404(25)00156-2. [Epub ahead of print]64 102341
    Comprehensive guide to the diagnosis, management, and treatment of metastatic spinal cord compression syndrome.
    Daniel Alejandro Vega Moreno, Gervith Reyes Soto, Julio Cesar Lopez-Valdes, Alfonso Arellano-Mata, Henar Galicia Palacios, Miguel Agustín Amador Hernandez, Manuel de Jesús Encarnación-Ramirez.
      Spinal metastases are the most common tumors found in the neuraxis. They correspond to 90 % of all tumors at this level. The thoracic region is the most frequently affected area, followed by the lumbar region, with the cervical region being the least frequently affected place. Back pain is the most common symptom, appearing in up to 95 % of patients who present with spinal cord compression syndrome. The evaluation of patients with spinal cord compression syndrome is complex and requires an entire multidisciplinary team for diagnosis, management, and treatment. In the medical part, treatment is based on pain control with analgesic medications and the use of steroids, mainly dexamethasone, which has demonstrated efficacy and safety in the context of patients with spinal cord compression syndrome for functional recovery. Radiotherapy treatment is essential both as a definitive treatment and as a complementary treatment to surgery and although to date there are several treatment schemes, doses and fractions must be individualized based on the clinical context of each patient. On the other hand, metastatic spinal surgery is considered part of the definitive treatment, and although in a palliative context there are multiple approaches and indications for it. The importance of considering surgery is in those patients who are unstable since surgery, although it is not curative, poses a substantial improvement in symptoms as well as in pain recovery. We propose a diagnosis and treatment algorithm for patients with metastatic spinal cord compression syndrome in which decision-making is based on individualization and joint management by a multidisciplinary team. CLINICAL TRIAL NUMBER: not applicable.
    Keywords:  Spinal cord compression; Spine instability; Spine metastasis
    DOI:  https://doi.org/10.1016/j.suronc.2025.102341
  2. World Neurosurg. 2025 Dec 12. pii: S1878-8750(25)01078-2. [Epub ahead of print] 124720
    Navigating the Surgical Dilemma in Metastatic Spine Disease: Does Age Influence Treatment Strategy and Outcomes?
    Meltem Ivren, Dilber Yalman, Basem Ishak, Sebastian Ille, Sandro M Krieg, Pavlina Lenga.
       OBJECTIVE: Spinal metastases are increasingly common. Yet, the optimal surgical strategy-particularly in elderly patients-remains debated due to perioperative risks. This study examines demographics, clinical presentation, and surgical outcomes, focusing on age-related differences and management of patients with Spinal Instability Neoplastic Score (SINS) 7-12.
    METHODS: We retrospectively included all patients with spinal metastases operated in our department from 2015-2024. Data on demographics, neurological status, surgical approach, complications and 90-day mortality were collected.
    RESULTS: 217 patients (median age: 60 years, range: 5-88) were included. Lung (17%), breast (17%), and prostate (12%) were the most common primaries. Older patients presented with worse neurological deficits (Frankel A/B: 36% vs. 5%, p < 0.01) but had comparable short-term mortality (≥65 years: 15% vs. <65 years: 13%, p = 0.837) and lower intraoperative blood loss (260 ± 373 mL vs. 759 ± 860 mL, p < 0.001). Surgical approaches were similar across age groups, with instrumentation in 32% and minimally invasive techniques in 18%. Regarding SINS, older patients were more frequently categorized as potentially unstable (65% vs. 38%, p < 0.001) yet more frequently treated with decompression. Younger patients undergoing instrumentation predominantly had SINS 7-18.
    CONCLUSIONS: Age alone does not determine surgical success or survival in metastatic spine disease. Despite worse baseline status, older patients achieved short-term outcomes comparable to younger patients. Variation in managing SINS 7-12 suggests underuse of instrumentation in older patients underscoring the need for age-inclusive evidence-based guidelines integrating SINS with tumor biology, functional status and prognosis.
    DOI:  https://doi.org/10.1016/j.wneu.2025.124720
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