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Review Question - QID 2896

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QID 2896 (Type "2896" in App Search)
You are caring for a 63-year-old female with metastatic breast cancer to the lumbar spine. Her neurological examination shows significant weakness in leg function and she is having difficulty ambulating. Imaging shows significant neural element compression by the tumor and complete erosion of the L1 vertebrae. She has no other sites of metastatic disease and is otherwise healthy. What treatment option do you recommend to best maintain her function?

Palliative therapy

1%

45/3933

Complete neural element decompression

0%

14/3933

Complete neural element decompression with instrumentation to stabilize the spine

9%

370/3933

Complete neural element decompression, instrumentation, and postoperative chemotherapy

23%

898/3933

Complete neural element decompression, instrumentation, and postoperative radiotherapy

66%

2590/3933

Select Answer to see Preferred Response

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Declining neurological function in patients with metastatic disease requires treatment.

In their landmark study, Patchell et al. evaluated the treatment of spinal cord compression from metastatic cancer via a randomized, multi-institutional trial that assigned 101 patients to surgery with postoperative radiotherapy vs. radiotherapy alone. The primary endpoint was the ability to walk after treatment. Secondary endpoints included urinary continence, muscle strength, functional status, need for corticosteroids and opioid analgesics, and overall survival time. They found that direct neural element decompression plus postoperative radiotherapy was superior to treatment with radiotherapy alone for patients with spinal cord compression caused by metastatic cancer.

Schmidt et al. and Klimo et al. reviewed the literature regarding single and multimodal treatment options for metastatic disease to the spine with and without direct spinal cord compression.

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