Vertebral metastasis of renal carcinoma at diagnosis: mechanical and clinical evaluation: surgical management / Metástasis vertebral de carcinoma renal en el momento del diagnóstico: evaluación mecánica y clínica: manejo quirúrgico
Int. j. med. surg. sci. (Print)
;
8(4): 1-9, dic. 2021. ilus
Article
in English
| LILACS
| ID: biblio-1348234
ABSTRACT
Renal cell carcinoma accounts for 2-3% of all malignant neoplasms. Metastatic disease of the spine is common and 50% of bone metastases are already present at the time of primary diagnosis. Bone metastases from renal cell carcinoma are difficult to manage, especially vertebral localization.A 48-year-old woman was diagnosed with renal cell carcinoma in the context of low back pain. The patient presented two skeleton metastases at diagnosis (T11 and 5th rib). The patient received neoadjuvant treatment with cabozantinib, followed by removal of the renal tumor. Radiotherapy was administered for the lumbar lesion. In spite of the radiotherapy treatment, increased low back pain limiting mobility and ambulation. MRI showed an occupation of the spinal canal, without neurological lesion. The SINS scale revealed a score of 14 (vertebral instability). The patient's prognosis was greater than 12 months according to the Tokuhashi score. Based on clinical and mechanical criteria, surgical treatment of the vertebral lesion was decided. T11 vertebrectomy was performed, the reconstruction was made with an expandable cage, and T8 a L2 posterior spinal arthrodesis. A partial resection of the fifth rib was performed in order to remove the whole macroscopic tumor. After 3 months, she was diagnosed with a local infection, treated by irrigation, debridement and antibiotherapy, with good evolution. At 1-year follow-up, she has no low back pain or functional limitation. Follow-up chest-abdomen-pelvis computed CT scan showed absence of disease progression, furthermore, the vertebral arthrodesis shows fusion signs. At the time of this report, there are no clinical or radiological data of infection
Full text:
Available
Index:
LILACS (Americas)
Main subject:
Spinal Neoplasms
/
Carcinoma, Renal Cell
/
Kidney Neoplasms
Type of study:
Diagnostic study
/
Prognostic study
Limits:
Female
/
Humans
Language:
English
Journal:
Int. j. med. surg. sci. (Print)
Journal subject:
Surgery
/
Medicine
Year:
2021
Type:
Article
Affiliation country:
Spain
Institution/Affiliation country:
University Hospital "Doce de Octubre"/ES
/
University Hospital "Niño Jesús"/ES
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