Trauma & Orthopaedics Page 1 of 7 Critic al r eview Spinal metastasis subjected to photodynamic therapy: an update W Jerjes 1,2 *, HB Tan 1 , C Hopper 2 , P Giannoudis 1 Abstract scribed. Vertebral body and epidural pecially when neurological abnor- space metastasis is more common malities are manifested. Bone single Introduction than intramedullary and intramural photon emission computed tomogra- This is a review of the evidence on ones. Two-thirds of the lesions are lo- phy (SPECT) and positron emission the use of photodynamic therapy in calized at the anterior portion of the tomography (PET) are modalities the management of bone lesions in vertebral body 1–4 . that may enable guiding the manage- spinal metastasis. All authors contributed to the conceptjon, design, and preparatjon of the manuscript, as well as read and approved the fjnal manuscript. Primary sources of the disease ment of spinal disease 2,3,4 . Materials and methods have been mainly identified in the The literature was searched for rele- lungs and breast. Spinal metastasis Current interventions vant articles and the results were ex- have also been known to result from To date, no treatment for this unfor- amined. The search included on-goi- other primary pathologies like gas- giving disease has proven to be ef- ng trials that aim to tackle this disea- trointestinal, kidney and prostate ma- fective in improving life expectancy; se. lignancies, lymphoma, melanoma and median survival in symptomatic pa- Results multiple myeloma 1,3 . tients with spinal metastasis does not Eight studies were identified in the Over two-thirds of the lesions are exceed 12 months. Patient’s quality literature; none were applied on hu- identified in the thoracic area (T4– of life is known to slightly improve mans. T7), one-fifth in the lumbar region after conventional interventions, eas- Conclusion and remaining in the cervical spine. ing the symptoms caused by bowel Photodynamic therapy is an effectiv- However, more than half of the pa- or bladder involvement as well as the e modality in managing osteoblastic tients have lesions at multiple levels. pain 1,3,4,6 . and/or osteolytic spinal bone metas- Along with the mass effect, axonal Therefore, it is fair to say that pain tasis. Evidence regarding the efficacy destruction and demyelination result control and functional preservation of this therapy suggests that it will h- following cord distortion. Venous in- are the main aims of any manage- ave a leading role in interventional All authors abide by the Associatjon for Medical Ethics (AME) ethical rules of disclosure. farction and haemorrhage result from ment. The efficacy of an interven - hard tissue oncology and thus we pr- vasogenic oedema and venous con- tion is usually judged through several opose a technique for managing such gestion; the effects of vascular com- functional scoring systems. Choosing pathology. promise 1–4 . between different interventions can Nearly all patients with symptom- be challenging and is usually judged Introduction Competjng interests: none declared. Confmict of interests: none declared. atic disease experience bone and/or by the patient’s presenting symptoms Spinal metastasis back pain. Sensory disturbances, ra- (i.e. pain related to bone destruction, Tumour metastasis to the spine is not diculopathy, motor dysfunction and pathological fractures or stretching of uncommon. It is the third most com- bladder and bowel involvement have the periosteum, while vertebral com- mon site for tumours to metastasize, been reported in half of the symp- pression and/or collapse causes axial after the lungs and liver. Up to 70% of tomatic cases 1–6 . pain), ability to function at the time of cancer patients (at autopsy) have spi- Radiological investigations in- presentation (i.e. ability to ambulate nal metastasis, but only 10% become clude plain X-rays to identify ver- is a favourable prognostic sign) and symptomatic. Spread is usually via tebral body and pedicles erosions psychological status (1,3,4,5,6) . arterial route, although direct inva- (i.e. owl-eye erosion of the pedicles At present, radiotherapy remains sion through intervertebral formina indicating metastatic disease), which the gold standard treatment for this and retrograde spread via Batson’s become identifiable when 30%–50% disease. Meanwhile, surgery is usually plexus have been previously de- of the bone is destroyed. Computed employed for patients with bony col- * Corresponding author tomographic imaging helps to assess lapse and/or acute neurological prob- Email: waseem_wk1@yahoo.co.uk the integrity of the vertebral column, lems. Pain is primarily managed with 1 Leeds Institute of Molecular Medicine, Leeds, while magnetic resonance imaging steroids and non-steroidal anti-in- UK (MRI) is the modality of choice, es- flammatory drugs, while neuropathic 2 UCL Department of Surgery, London, UK Licensee OA Publishing London 2012. Creative Commons Attribution License (CC-BY) For citation purposes: Jerje s W , T an HB, Hopper C, Giannoudis PV. Spinal metastasis subjected to photodynamic therapy: an update. Hard Tissue. 2012 Nov 10;1(1):8.
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