ROLE OF ORTHOPAEDICS IN METASTATIC PATHOLOGICAL FRACTURES
Advancements in oncological and medical therapies mean that the life expectancy of the patients with Metastatic Bone Disease (MBD) is usually measured in years. Complications of Metastatic Bone Disease (MBD) can affect the patient’s quality of life, so making careful assessment and appropriate management of those patients is essential.
The roles of orthopaedic and spinal surgeons in MBD generally fall into one of four categories: diagnosis, the prophylactic fixation of metastatic deposits at risk of impending fracture (preventative surgery), the reconstruction of bones affected through pathological fractures (reactive surgery), or the decompression and stabilisation of the vertebral column, spinal cord and nerve roots.
Several key principles should be adhered to whenever operating on skeletal metastases. Discussions should be done early with an appropriate multi-disciplinary team before the intervention. A detailed pre-assessment is important to gauge a patient’s suitability for the surgery – recovery from elective surgery should be shorter than the anticipated survival. Staging and biopsies provide prognostic information. Primary bone tumours should be ruled out in the case of a solitary bone lesion to avoid inappropriate intervention. Prophylactic surgical fixation of a lesion before a pathological fracture reduces the morbidity and length of hospital stay. Regardless of a lesion or pathological fracture’s location, all regions of the affected bone must be addressed, to reduce the risk of subsequent fracture. Surgical implants should enable full weight bearing or return to function immediately. Post-operative radiation therapy should be utilised in all cases to minimise the progression of disease.
Spinal surgery should be considered for those with spinal pain because of doubtless reversible spinal instability or neurological compromise. The opinion of a spinal surgeon should be sought as soon as possible, because delays in referral directly correlate to worse functional recovery following intervention. Patients who suffer a slowly progressive deficit, present within hours of complete neurological deficit, or have compression caused by bone alone are those most likely to benefit from surgery. Back pain in the presence of MBD should be regarded as impending spinal cord compression and investigated urgently to allow intervention prior to the development of neurological compromise.
MS (Ortho) HOD & Consultant Orthopaedics