Improvements in detection, decompressive surgical technique, and radiotherapeutic techniques have significantly improved our ability to identify and treat spine malignancies. These innovations have allowed for decision-making algorithms that value quality of life and function along with quantity of life when deciding among the various therapeutic options. Despite these advances, significant barriers to rehabilitation of patients with spinal malignancies remain. These barriers include deficits in the neurologic, oncologic, medical, pain, and social support status of the patient. This article will review these barriers and discuss management strategies that emphasize the importance of diagnostic accuracy and a comprehensive team approach.
Sciubba DM, Ziya LG. Diagnosis and management of metastatic spine disease. Surg Oncol. 2006;15:141–151
,
Diagnosis and management of metastatic spine disease
, Surg Oncol.
, vol. 15
(pg. 141
-151
) Delea T, Langer C, McKiernan J, et al. The cost of treatment of skeletal-related events in patients with bone metastases from lung cancer. Oncology. 2004;67:390–396.
,
The cost of treatment of skeletal-related events in patients with bone metastases from lung cancer
, Oncology
, vol. 67
(pg. 390
-396
) Patchell RA, Posner JB. Neurologic complications of systemic cancer. Neurol Clin. 1985;3:729–750.
,
Neurologic complications of systemic cancer
, Neurol Clin.
, vol. 3
(pg. 729
-750
) Plotkin SR, Wen PY. Neurologic complications of cancer therapy. Neurol Clin. 2003; 21:279–318.
,
Neurologic complications of cancer therapy
, Neurol Clin.
, vol. 21
(pg. 279
-318
) Okada S, Okeda R. Pathology of radiation myelopathy. Neuropathology. 2001;21:247–265.
,
Pathology of radiation myelopathy
, Neuropathology
, vol. 21
(pg. 247
-265
) Falah M, Schiff D, Burns TM. Neuromuscular complications of cancer diagnosis and treatment. J Support Oncol. 2005;3:271–282.
,
Neuromuscular complications of cancer diagnosis and treatment
, J Support Oncol.
, vol. 3
(pg. 271
-282
) Bilsky MS. New therapeutics in spine metastases. Expert Rev Neurotherapeutics. 2005;5:831–840.
,
New therapeutics in spine metastases
, Expert Rev Neurotherapeutics
, vol. 5
(pg. 831
-840
) Stubblefield MD, Bilsky MH. Barriers to rehabilitation of the neurosurgical spine caner patient. J Surg Oncol. 2007;95:419–426.
,
Barriers to rehabilitation of the neurosurgical spine caner patient
, J Surg Oncol.
, vol. 95
(pg. 419
-426
) Murray PK. Functional outcome and survival in spinal cord injury secondary to neoplasia. Cancer. 1985; 55:197–201.
,
Functional outcome and survival in spinal cord injury secondary to neoplasia
, Cancer
, vol. 55
(pg. 197
-201
) Maranzano E, Latini P, Checcaglini F, et al. Radiation therapy in metastatic spinal cord compression. A prospective analysis of 105 consecutive patients. Cancer. 1991;67:1311–1317.
,
Radiation therapy in metastatic spinal cord compression. A prospective analysis of 105 consecutive patients
, Cancer
, vol. 67
(pg. 1311
-1317
) Helweg-Larsen S. Clinical outcome in metastatic spinal cord compression. A prospective study of 153 patients. Acta Neurol Scand. 1996:94:269–275.
,
Clinical outcome in metastatic spinal cord compression. A prospective study of 153 patients
, Acta Neurol Scand.
, vol. 94
(pg. 269
-275
) Patchell RA, Tibbs PA, Regine WF, et al. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: A randomized trial. Lancet. 2005;336:643–648.
,
Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: A randomized trial
, Lancet
, vol. 336
(pg. 643
-648
) Yamada Y, Bilsky MH, Lovelock M, et al. High-dose single-fraction image-guided intensity-modulated radiotherapy for metastatic spinal lesions. Int J Radiation Oncol Biol Phys. 2008;71:484–490.
,
High-dose single-fraction image-guided intensity-modulated radiotherapy for metastatic spinal lesions
, Int J Radiation Oncol Biol Phys.
, vol. 71
(pg. 484
-490
) Wang JC, Boland P, Mitra N, et al. Single-stage posterolateral transpedicular approach for resection of epidural metastatic spine tumors involving the vertebral body with circumferential reconstruction: Results in 140 patients. J Neurosurg (Spine 1). 2004;3:287–298.
,
Single-stage posterolateral transpedicular approach for resection of epidural metastatic spine tumors involving the vertebral body with circumferential reconstruction: Results in 140 patients
, J Neurosurg (Spine 1)
, vol. 3
(pg. 287
-298
) American Spinal Injury Association. International Standards for Neurological Classification of Spinal Cord Injury, revised 2002. Chicago, IL: American Spinal Injury Association; 2002.
Oken MM, Creech RH, Tormey DC, et al. Toxicity and response criteria of the eastern cooperative oncology group. Am J Clin Oncol. 1982;5:649–655.
,
Toxicity and response criteria of the eastern cooperative oncology group
, Am J Clin Oncol.
, vol. 5
(pg. 649
-655
) Tatli YZ, Stubblefield MD, Custodio CM. Spinal ataxia from Ewing’s sarcoma: A case report. Arch Phys Med Rehabil. 2004;85:E49.
,
Spinal ataxia from Ewing’s sarcoma: A case report
, Arch Phys Med Rehabil.
, vol. 85
pg. E49
Yalamanchili M, Lesser GJ. Malignant spinal cord compression. Curr Treat Options Oncol. 2003;4:509–516.
,
Malignant spinal cord compression
, Curr Treat Options Oncol.
, vol. 4
(pg. 509
-516
) Batchelor TT, Yaylor LP, Thaler HT, Posner JB, DeAngelis LM. Steroid myopathy in cancer patients. Neurology. 1997;48:1234–1238.
,
Steroid myopathy in cancer patients
, Neurology
, vol. 48
(pg. 1234
-1238
) Laskin JJ, Sandler AB. First-line treatment for advanced non-small-cell lung cancer. Oncology. 2005;19:1671–1676.
,
First-line treatment for advanced non-small-cell lung cancer
, Oncology
, vol. 19
(pg. 1671
-1676
) Andre F. Slimane K, Bachelot T, et al. Breast cancer with synchronous metastases: Trends in survival during a 14-year period. J Clin Oncol. 2004;22:3302–3308.
,
Breast cancer with synchronous metastases: Trends in survival during a 14-year period
, J Clin Oncol.
, vol. 22
(pg. 3302
-3308
) Guo Y, Young B, Lynn Palmer J, Mun Y, Bruera E. Prognostic factors for survival in metastatic spinal cord compression-a retrospective study in a rehabilitation setting. Am J Phys Med Rehabil. 2003;82:665–668.
,
Prognostic factors for survival in metastatic spinal cord compression-a retrospective study in a rehabilitation setting
, Am J Phys Med Rehabil.
, vol. 82
(pg. 665
-668
) Heary RF, Bono CM. Metastatic spinal tumors. Neurosurg Focus. 2001;11:1–9.
,
Metastatic spinal tumors
, Neurosurg Focus
, vol. 11
(pg. 1
-9
) Bilsky MH, Boland PJ, Panageas KS, Woodruff JM, Brennan MF, Healey JH. Intralesional resection of primary and metastatic sarcoma involving the spine: Outcome analysis of 59 patients. Neurosurgery. 2001;49:1277–1287.
,
Intralesional resection of primary and metastatic sarcoma involving the spine: Outcome analysis of 59 patients
, Neurosurgery
, vol. 49
(pg. 1277
-1287
) McKinley WO, Huang ME, Tewksbury MA. Neoplastic vs. traumatic spinal cord injury: An inpatient rehabilitation comparison. Am J Phys Med Rehabil. 2000;79:138–144.
,
Neoplastic vs. traumatic spinal cord injury: An inpatient rehabilitation comparison
, Am J Phys Med Rehabil.
, vol. 79
(pg. 138
-144
) Rades D, Veninga T, Staplers LJA, et al. Prognostic factors predicting functional outcomes, recurrence-free survival, and overall survival after radiotherapy for metastatic spinal cord compression in breast cancer patients. Int J Radiation Oncology Biol Phys. 2006;64:182–188.
,
Prognostic factors predicting functional outcomes, recurrence-free survival, and overall survival after radiotherapy for metastatic spinal cord compression in breast cancer patients
, Int J Radiation Oncology Biol Phys.
, vol. 64
(pg. 182
-188
) Chen MJ, Fan X, Moe ST. Criterion-related validity of the Borg ratings of perceived exertion scale in healthy individuals: A meta-analysis. J Sports Sci. 2002;20:873–899.
,
Criterion-related validity of the Borg ratings of perceived exertion scale in healthy individuals: A meta-analysis
, J Sports Sci.
, vol. 20
(pg. 873
-899
) Cheville AL. Pain management in cancer rehabilitation. Arch Phys Med Rehabil. 2001; 82(Suppl1):S84–S87.
,
Pain management in cancer rehabilitation
, Arch Phys Med Rehabil
, vol. 82
(pg. S84
-S87
) Portenoy RK, Lessage P. Management of cancer pain. Lancet. 1999;353:1695–1700.
,
Management of cancer pain
, Lancet
, vol. 353
(pg. 1695
-1700
) Woolf CJ. Pain: Moving from symptom control toward mechanism-specific pharmacologic management. Ann Intern Med. 2004;140:441–451.
,
Pain: Moving from symptom control toward mechanism-specific pharmacologic management
, Ann Intern Med.
, vol. 140
(pg. 441
-451
) Ripamonti C, Fulfaro F. Pathogenesis and pharmacological treatment of bone pain in skeletal metastases. Q J Nucl Med. 2001;45:65–77.
,
Pathogenesis and pharmacological treatment of bone pain in skeletal metastases
, Q J Nucl Med.
, vol. 45
(pg. 65
-77
) Mercadante S. Malignant bone pain: Pathophysiology and treatment. Pain. 1997;69:1–18.
,
Malignant bone pain: Pathophysiology and treatment
, Pain
, vol. 69
(pg. 1
-18
) Coleman RE. Metastatic bone disease: Clinical features, pathophysiology and treatment strategies. Cancer Treat Rev. 2001;27:165–176.
,
Metastatic bone disease: Clinical features, pathophysiology and treatment strategies
, Cancer Treat Rev
, vol. 27
(pg. 165
-176
) Bilsky MH, Lis E, Raizer J, Lee H, Boland P. The diagnosis and treatment of metastatic spinal tumor. Oncologist. 1999; 4:459–469.
,
The diagnosis and treatment of metastatic spinal tumor
, Oncologist
, vol. 4
(pg. 459
-469
) Hill ME, Richards MA, Gregory WM, Smith P, Rubens RD. Spinal cord compression in breast cancer: A review of 70 cases. Br J Cancer. 1993;68:969–973.
,
Spinal cord compression in breast cancer: A review of 70 cases
, Br J Cancer
, vol. 68
(pg. 969
-973
) Prasad D. Schiff D. Malignant spinal-cord compression. Lancet Oncol. 2005;6:15–24.
,
Malignant spinal-cord compression
, Lancet Oncol.
, vol. 6
(pg. 15
-24
) Posner JB. Neurologic Complications of Cancer. Philadelphia: FA Davis; 1995:111–142.
,
Neurologic Complications of Cancer
(pg. 111
-142
) Falah M, Schiff D, Burns TM. Neuromuscular complications of cancer diagnosis and treatment. J Support Oncol. 2005;3:271–282.
,
Neuromuscular complications of cancer diagnosis and treatment
, J Support Oncol.
, vol. 3
(pg. 271
-282
) Dworkin RH. An overview of neuropathic pain: Syndromes, symptoms, signs, and several mechanisms. Clin J Pain. 2002;18:343–349.
,
An overview of neuropathic pain: Syndromes, symptoms, signs, and several mechanisms
, Clin J Pain
, vol. 18
(pg. 343
-349
) Visovsky C. Chemotherapy-induced peripheral neuropathy. Cancer Invest. 2003;21:439–451.
,
Chemotherapy-induced peripheral neuropathy
, Cancer Invest
, vol. 21
(pg. 439
-451
) Hauer-Jensen M, Fink LM, Wang J. Radiation injury and the protein C pathway. Crit Care Med. 2004;32(Suppl.):S325–S330.
,
Radiation injury and the protein C pathway
, Crit Care Med.
, vol. 32
(pg. S325
-S330
) Stubblefield MD, Slovin S, MacGregor-Cortelli B, et al. An electrodiagnostic evaluation of the impact of pre-existing peripheral nervous system disorders in patients treated with the novel proteasome inhibitor bortezomib. Clin Oncol. 2006;18:410–418.
,
An electrodiagnostic evaluation of the impact of pre-existing peripheral nervous system disorders in patients treated with the novel proteasome inhibitor bortezomib
, Clin Oncol.
, vol. 18
(pg. 410
-418
) Stubblefield MD, Custodio CM. Upper-extremity pain disorders in breast cancer. Arch Phys Med Rehabil. 2006;87(3 Suppl):96–99.
,
Upper-extremity pain disorders in breast cancer
, Arch Phys Med Rehabil.
, vol. 87
(pg. 96
-99
) Herrera JE, Stubblefield MD. Rotator cuff tendonitis in lymphedema: A retrospective case series. Arch Phys Med Rehabil. 2004;85:1939–1942.
,
Rotator cuff tendonitis in lymphedema: A retrospective case series
, Arch Phys Med Rehabil.
, vol. 85
(pg. 1939
-1942
) Braddom RL. Medicare funding for inpatient rehabilitation: How did we get to this point and what do we do now? Arch Phys Med Rehabil. 2005;86:1287–1292.
,
Medicare funding for inpatient rehabilitation: How did we get to this point and what do we do now?
, Arch Phys Med Rehabil.
, vol. 86
(pg. 1287
-1292
) McKinley WO, Conti-Wyneken AR, Vokac CW, Cifu DX. Rehabilitative functional outcome of patients with neoplastic spinal cord compression. Arch Phys Med Rehabil. 1996;77:892–895.
,
Rehabilitative functional outcome of patients with neoplastic spinal cord compression
, Arch Phys Med Rehabil.
, vol. 77
(pg. 892
-895
) Eriks IE, Angenot ELD, Lankhort GJ. Epidural metastatic spinal cord compression: Functional outcome and survival after inpatient rehabilitation. Spinal Cord. 2004;42:235–239.
,
Epidural metastatic spinal cord compression: Functional outcome and survival after inpatient rehabilitation
, Spinal Cord
, vol. 42
(pg. 235
-239
)
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