Current Incidence of Different Morphological Types of Malignant Metastases to the Spine Based on Magnetic Resonance Imaging Grzegorz Guzik Ortop Traumatol Rehabil 2017; 19(2):137-144 ICID: 1238001
Article type: Original article
IC™ Value: 3.00
Abstract provided by Publisher
Background. Malignant tumours particularly often metastasise to the spine, causing considerable pain and limiting the patient’s physical function. Standard therapy consists in surgical treatment with adjuvant radiotherapy. The qualification for surgery is a multifaceted process and detailed analysis of the morphology of the metastasis is a key factor. Numerous types of classification of metastatic lesions exist, among which the Tomita system, based on MRI findings, appears to be the most practical. The aim of this paper is to present the current incidence of different morphological types of metastases as classified by the Tomita system. Materials and methods. This work was based on cases treated at the Department of Oncological Orthopaedics of the Specialist Hospital in Brzozów - Podkarpacie Oncological Centre from 2010-2015. A total of 854 patients with spinal metastases were hospitalised at the department. All patients underwent a CT and MRI of the spine and their metastatic lesions were classified as one of the 7 types described by Tomita. The incidence of different morphological types of metastases per type of the primary tumour was also determined. Results. Most patients treated at the department had advanced disease as a result of diagnostic delays. Types T3-T7 were found in 91% of the patients and T7 in 44%. The highest incidence of advanced disease was seen among patients with breast cancer and myeloma. Higher pain severity and incidence of neurological complications were noted in patients with multisite lesions. Neurological deficits were diagnosed in 228 patients, of whom 68% were classified as Type T6 or T7. Most of the T6/T7 patients were unable to walk unassisted and required constant help from their family or medical staff. Conclusions. 1. The Tomita system allows for simple assessment of the morphology of metastases located in the spine 2. The majority of the patients diagnosed have advanced multisite and infiltrating metastases classified as T6/T7 in the Tomita system (66%). 3. Pain severity, physical function limitation and the rate of neurological complications increase visibly in more advanced metastatic disease of the spine. 4. The highest number of advanced metastases was found in patients with metastatic breast cancer and multiple myeloma.