Concepts and Surgical Treatment of Metastatic Bone Disease

This chapter focuses on treatment that affects the neoplastic process as well as the bone microenvironment. It discusses the molecular events related to metastatic bone disease. The chapter summarizes the use of bisphosphonate therapy as well as surgical stabilization. Upon arrival in bone, tumor cells begin a reciprocal (bilateral) interaction with the bone microenvironment. This interaction fosters tumor growth while offsetting the normally balanced process of bone remodeling toward either net bone destruction or formation, causing significant morbidity. The most common site of bone metastasis is the thoracic spine. If patients are neurologically intact and there are no fracture fragments impinging on the spinal cord, radiation is often the treatment of choice. Kyphoplasty and vertebroplasty are commonly used techniques for patients who have osteolytic spine metastasis without neurologic compromise.