10 Tips on Spinal Tumors for Palliative Care

Practical advice was so compelling had to summarize it. Best get the full article though.

J Palliat Med. 2018 Dec 20. doi: 10.1089/jpm.2018.0608. [Epub ahead of print]
Top Ten Tips Palliative Care Clinicians Should Know About Spinal Tumors.
Williamson T. et al
https://www.ncbi.nlm.nih.gov/pubmed/30570435

1: All Tumors Are Not Created Equal: Intradural and Extradural Tumors Have Different Work-up and Management

Intradural – 3-4 yrs gradual onset radiculitis or back pain; cervical or thoracic – spasticity, unsteady gait, weakness, hyper-reflexia; benign – resected if can

extradural – metastatic often bone tumors; CT for bony destruction and MRI for epidural compression;  – surgical resection or stabilization, chem/radiotherapy

2) Refer to a Surgeon for Resection, Tissue Diagnosis, Intractable Pain, Instability, or Neurological Deficit
-local tumor control and resection – malignant chordomas are often surgical but rest not. Intradural benign tumors surgical
– tissue diagnosis
-spinal instability and uncontrolled pain
– neurological deficit , epidural spinal compression

3)Neurosurgeons Utilize Diagnostic and Prognostic Scoring Systems to Stratify Surgical Decisions

spinal mets decide

4) How to Make a Good Referral and What to Do “On the Ground” Before Referring: A Cheat Sheet
Answer 4 questions:

1. Do they have mechanical pains? – eg instability – pain more with activity plus imaging
2. Is tumor radiosensitive?
3. Do they have spinal compression with myelopathy?
4. What is their systemic burden of disease/prognosis?

for compression dexamethasone 10 stat then 4 mg q6h – watch sugars and use ppi; consider bracing and pain management

5: Minimally Invasive Treatment Options Provide Palliative Options for Pain Management
– Kyphoplasty and vertebroplasty
– radiotherapy for lymphoma, multiple myeloma, small cell lung carcinoma, seminoma, neuroblastoma, and Ewing’s sarcoma, and post surgical. – beware more instability 30-180 days after.

6: Maximally Invasive Treatment Options Provide Tumor Control and Improve Outcomes in the Right Patients

  • Decompressive laminectomy plus fusion

7: Comprehensive Post-operative Care Improves Patient Outcomes
– inpatient rehab
– bracing

8: Post-operative Plan: Expect Complications but Limit Them with Excellent Post-operative Care
– interdisciplinary collaboration
-advanced wound closure
– adequate nutrition,
– planning of adjuvant therapy

9: Why Two Patients with the Same MRI Scan and Symptoms Get Different Treatments? -Patient-Specific Factors Dictate Management Options
– Individualized multidisciplinary decision

10: Surgery for Spine Tumor Patients Can Mean Improved Quality of Life

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