El papel de la cirugía mínimamente invasiva de columna en el tratamiento de las metástasis vertebrales (parte 1): una revisión clínica / The role of minimally invasive spine surgery in the treatment of vertebral metastasis (part 1): A clinical review

Las metástasis espinales representan una importante carga sobre la calidad de vida en los pacientes afectados por una enfermedad oncológica activa, debido a la alta incidencia de síndromes dolorosos, deformidad espinal y deterioro neurológico. La cirugía juega un papel determinante a la hora de mejorar la calidad de vida mediante el control del dolor, el restablecimiento de la función neurológica y el mantenimiento de la estabilidad espinal, además de contribuir a la respuesta de la terapia médica. La cirugía mínimamente invasiva (MIS) es una opción de tratamiento en determinados pacientes con alto riesgo quirúrgico, ya que tiene una baja tasa de complicaciones, de sangrado intraoperatorio, de estancia hospitalaria y ofrece resultados similares a la cirugía abierta. Presentamos en esta revisión el papel de la MIS en esta enfermedad, y algunos casos tratados en nuestro centro hospitalario.(AU)

Spinal metastases represent a significant burden on the quality of life in patients affected by active oncological disease due to the high incidence of pain syndromes, spinal deformity, and neurological impairment. Surgery plays a decisive role in improving quality of life by controlling pain, restoring neurological function and maintaining spinal stability, as well as contributing to the response to medical therapy. Minimally invasive surgery (MIS) is a treatment option in certain patients with high surgical risk since it has a low rate of complications, intraoperative bleeding, hospital stay, and offers similar results to open surgery. In this review, we present the role of MIS in this pathology and some cases treated in our hospital.(AU)

[Translated article] The role of minimally invasive spine surgery in the treatment of vertebral metastasis (Part 1): A clinical review / El papel de la cirugía mínimamente invasiva de columna en el tratamiento de las metástasis vertebrales (parte 1): una revisión clínica

Las metástasis espinales representan una importante carga sobre la calidad de vida en los pacientes afectados por una enfermedad oncológica activa, debido a la alta incidencia de síndromes dolorosos, deformidad espinal y deterioro neurológico. La cirugía juega un papel determinante a la hora de mejorar la calidad de vida mediante el control del dolor, el restablecimiento de la función neurológica y el mantenimiento de la estabilidad espinal, además de contribuir a la respuesta de la terapia médica. La cirugía mínimamente invasiva (MIS) es una opción de tratamiento en determinados pacientes con alto riesgo quirúrgico, ya que tiene una baja tasa de complicaciones, de sangrado intraoperatorio, de estancia hospitalaria y ofrece resultados similares a la cirugía abierta. Presentamos en esta revisión el papel de la MIS en esta enfermedad, y algunos casos tratados en nuestro centro hospitalario.(AU)

Spinal metastases represent a significant burden on the quality of life in patients affected by active oncological disease due to the high incidence of pain syndromes, spinal deformity, and neurological impairment. Surgery plays a decisive role in improving quality of life by controlling pain, restoring neurological function and maintaining spinal stability, as well as contributing to the response to medical therapy. Minimally invasive surgery (MIS) is a treatment option in certain patients with high surgical risk since it has a low rate of complications, intraoperative bleeding, hospital stay, and offers similar results to open surgery. In this review, we present the role of MIS in this pathology and some cases treated in our hospital.(AU)

[Translated article] The role of minimally invasive spine surgery in the treatment of vertebral metastasis (Part 1): A clinical review.

Spinal metastases represent a significant burden on the quality of life in patients affected by active oncological disease due to the high incidence of pain syndromes, spinal deformity, and neurological impairment. Surgery plays a decisive role in improving quality of life by controlling pain, restoring neurological function and maintaining spinal stability, as well as contributing to the response to medical therapy. Minimally invasive surgery (MIS) is a treatment option in certain patients with high surgical risk since it has a low rate of complications, intraoperative bleeding, hospital stay, and offers similar results to open surgery. In this review, we present the role of MIS in this pathology and some cases treated in our hospital.

The role of minimally invasive spine surgery in the treatment of vertebral metastasis (part 1): A clinical review. / El papel de la cirugía mínimamente invasiva de columna en el tratamiento de las metástasis vertebrales (parte 1): una revisión clínica.

Spinal metastases represent a significant burden on the quality of life in patients affected by active oncological disease due to the high incidence of pain syndromes, spinal deformity, and neurological impairment. Surgery plays a decisive role in improving quality of life by controlling pain, restoring neurological function and maintaining spinal stability, as well as contributing to the response to medical therapy. Minimally invasive surgery (MIS) is a treatment option in certain patients with high surgical risk since it has a low rate of complications, intraoperative bleeding, hospital stay, and offers similar results to open surgery. In this review, we present the role of MIS in this pathology and some cases treated in our hospital.

Metástasis espinal por carcinoma de células de Merkel en paciente inmunodeprimido: caso clínico / Merkel cell carcinoma spinal metastases in an immunosuppressed patient: Clinical case

El carcinoma de células de Merkel es un tumor cutáneo maligno poco frecuente, originado a partir de las células neuroendocrinas de la epidermis, denominadas células de Merkel. Presenta un pronóstico infausto cuando la enfermedad es diseminada. Dentro de las metástasis a distancia, la localización espinal es muy poco frecuente y no existe un consenso en cuanto a su manejo. Presentamos el segundo caso descrito en la literatura hasta el momento de afectación metastásica espinal por carcinoma de células de Merkel en paciente inmunodeprimido (AU)

Merkel cell carcinoma is a rare epidermal malignant tumor arised from neuroendocrine epidermal cells, called Merkel cells. Prognosis is poor when tumor spreads to distant locations. Among metastases sites, spinal is not frequent at all and its management remains controversial. We present the second reported case of spinal metastases from Merkel cell carcinoma in an immunosuppressed patient (AU)

Merkel cell carcinoma spinal metastases in an immunosuppressed patient: Clinical case. / Metástasis espinal por carcinoma de células de Merkel en paciente inmunodeprimido: caso clínico.

Merkel cell carcinoma is a rare epidermal malignant tumor arised from neuroendocrine epidermal cells, called Merkel cells. Prognosis is poor when tumor spreads to distant locations. Among metastases sites, spinal is not frequent at all and its management remains controversial. We present the second reported case of spinal metastases from Merkel cell carcinoma in an immunosuppressed patient.

Stereotactic body radiation therapy and minimally invasive surgery in the management of spinal metastases: a change in the paradigm. / Radioterapia estreotáxica corporal y cirugía mínimamente invasiva en el manejo de las metástasis espinales: un cambio de paradigma.

The main goal of treatment in spinal metastatic patients is local control of the disease, pain relief and the maintenance of ambulation. Traditionally, wide surgical resection of the tumour followed by adjuvant radiation and/or chemotherapy has been recommended. Currently, single-fraction or hypofractionated stereotactic body radiation therapy (SBRT) yields a one-year local control rate of over 95% with minimum morbidity, even for tumours previously considered radioresistant. In addition, by posterolateral and circumferential decompression and stabilisation of the spinal cord, it is feasible to create a 2 to 3 mm epidural margin between the dura mater and the tumour (separation surgery), enough to deliver safe and ablative doses of SBRT to the vertebrae. As these patients tend to be frail, such interventions should ideally be minimally invasive, thereby reducing surgical aggressiveness and helping to minimise the delay of any systemic therapies.