脊柱轉(zhuǎn)移性腫瘤骨折風(fēng)險的預(yù)測及預(yù)防性治療的基礎(chǔ)研究的綜述報(bào)告

脊柱轉(zhuǎn)移性腫瘤骨折風(fēng)險的預(yù)測及預(yù)防性治療的基礎(chǔ)研究的綜述報(bào)告IntroductionSpinalmetastasesarethemostcommontypeofmalignanttumorsaffectingthespine.Theycanleadtoseverecomplicationssuchasspinalcordcompression,vertebralbodyfractures,andinstability,whichcanresultinpain,neurologicalsymptoms,andfunctionaldisability.Vertebralbodyfractureisoneofthemostcommoncomplicationsofspinalmetastases,whichcanleadtoseverepain,deformity,andprogressivelossoffunction.Theincidenceofvertebralbodyfracturevariesamongdifferenttypesofmalignanciesandrangesfrom8%to54%.Theriskofvertebralbodyfractureisinfluencedbyvariousfactors,includingthelocationofmetastases,thedegreeofbonyinvolvement,andthetypeandaggressivenessoftheprimarymalignancy.Thepreventionandmanagementofvertebralbodyfractureinpatientswithspinalmetastasesrepresentanimportantclinicalchallenge.Inrecentyears,variousstrategieshavebeendevelopedtoestimatetheriskofvertebralbodyfractureandtopreventitsoccurrence.Thisreviewsummarizesthecurrentknowledgeonthepredictionandpreventionofvertebralbodyfractureinpatientswithspinalmetastases,withafocusontherecentadvancesindiagnosisandtreatment.RiskFactorsforVertebralBodyFractureinSpinalMetastasesTheriskfactorsforvertebralbodyfractureinpatientswithspinalmetastasesaremultifactorialandincludetumor-relatedfactorsaswellashost-relatedvariables.Thelocationanddegreeofvertebralinvolvementbymetastaticdiseasearecriticaldeterminantsoftheriskofvertebralbodyfracture.Lesionslocatedinthethoracicspinearemorelikelytocausevertebralbodyfracturethanthoseinthelumbarorcervicalspine.Lesionsthatinvolvemorethan50%ofthevertebralbodyheightareassociatedwithahigherriskoffracture.Thetypeofprimarymalignancyalsoinfluencestheriskofvertebralbodyfracture,withbreastandprostatecancerscarryingalowerriskthanlung,colon,orkidneycancers.Host-relatedfactorsthatcontributetotheriskofvertebralbodyfractureincludeage,sex,bonedensity,andprevioushistoryoffractures.Olderageandfemalesexareassociatedwithanincreasedriskoffracture,whilehigherbonedensityisprotective.Patientswithaprevioushistoryoffracturearealsoatanincreasedriskofsubsequentfractures.AssessmentofRiskofVertebralBodyFractureSeveraltoolshavebeendevelopedtoevaluatetheriskofvertebralbodyfractureinpatientswithspinalmetastases.OneofthemostwidelyusedistheSpinalInstabilityNeoplasticScore(SINS),whichisbasedonfiveradiographicfeaturesofspinalinstability:locationofthelesion,extentofvertebralbodyinvolvement,involvementofposteriorelements,degreeofvertebralbodycollapse,andpresenceofspinaldeformity.TheSINSscorerangesfrom0to18,andhigherscoresindicateahigherriskofinstabilityandfracture.OthertoolsthathavebeendevelopedtoassesstheriskofvertebralbodyfractureincludetheTokuhashiscoreandthemodifiedBauerscore.TheTokuhashiscoreisbasedonsixfactors:generalcondition,numberofextraspinalbonemetastases,numberofvertebralmetastases,involvementofmajororgans,andspinalcordorrootcompression.ThemodifiedBauerscoreusesthreeradiographicparameters:thepercentageofvertebralbodyinvolvement,bonequality,andpresenceofposteriorelementinvolvement.PreventionandTreatmentofVertebralBodyFractureThepreventionandtreatmentofvertebralbodyfracturesinpatientswithspinalmetastasesinvolveseveralapproaches,includingsystemictherapy,localtreatmentofthetumor,andvertebralaugmentationprocedures.Systemictherapywithchemotherapyorhormonaltherapycanachievetumorcontrolandimprovebonestrength,whichcanreducetheriskofvertebralbodyfracture.Bisphosphonatesanddenosumabarebone-modifyingagentsthatcanpreventosteoporosisandreducetheriskofskeletal-relatedevents,includingvertebralbodyfracture.Localtreatmentsofthetumor,suchasradiationtherapy,canachievetumorcontrolandreducetheriskofvertebralbodyfracture.Spinalstabilizationsurgerycanbeperformedtoenhancestabilityinselectedpatientswithhigh-riskspinalmetastases.Vertebralaugmentationprocedures,suchasvertebroplastyandkyphoplasty,canbeusedtostabilizepainfulvertebralfracturesandpreventprogressivedeformity.ConclusionVertebralbodyfractureisacommoncomplicationofspinalmetastasesthatcancausesignificantmorbidityinaffectedpatients.Severalriskfactorsforfracturehavebeenidentified,andseveraltoolshavebeendevelopedtoassesstheriskoffracture.Amultimodalapproachthatcombinessystemictherapy,localtreatmentofthetumor,andvertebralaugmentationprocedurescanre