Metastasis and primary tumours of the thoracolumbar spine


A 46-year-old patient suffers from breast cancer. She has lost weight and feels debilitated. To add to her health issues, she has very strong back pain since the last few days. Based on CT analysis, the cause of this pain is a pathological fracture with tumour involvement (metastasis) of the eleventh thoracic (T11) vertebral body. She can no longer walk upright without strong painkillers and is also unable to carry out her necessary everyday activities without the help of others.


The initial question is whether her complaints are actually related to breast cancer. After a thorough examination of the whole body, it is clear that the tumour has already spread into different regions of the body as well as the spine. The problem remains of how to deal with the painful, pathological T11 fracture.


Most of the pain is caused by the collapse of the T11 vertebral body. This instability is a potential danger that may cause paralysis. Further tumour growth or fractures of the vertebral column with a complete loss of spine stability must therefore be considered.

The operation serves to remove the affected vertebral body together with as much of the local tumour tissue as possible. At the same time, the necessary stability of the spine must be restored, e.g. with a vertebral body replacement implant. Before the procedure, the blood supply to the vertebra and metastasis is specifically suppressed (tumour embolization) with the assistance of a radiologist. The replacement implant is then inserted via an anterior (front) approach. The screws and rods are inserted through the skin (percutaneously) with the aid of a minimally invasive procedure, so that a large cut in the back is unnecessary. Wound healing is quicker and the oncological aftercare with radiation can be started earlier.

In particular, tumour diseases should only be treated by a team of specialists from different disciplines (tumour board). The overall treatment procedure depends on the right choice of the different available treatments; in this case, the procedure should always be coordinated individually for the patient and in conjunction with an interdisciplinary, high level of expertise.