Current Incidence of Different Morphological Types of Malignant Metastases to the Spine Based on Magnetic Resonance Imaging.

BACKGROUND

Malignant tumours particularly often metastasise to the spine, causing considerable pain and limiting the patient's physical function. Standard therapy consists in surgical treatment with adjuvant radiotherapy. The qualification for surgery is a multifaceted process and detailed analysis of the morphology of the metastasis is a key factor. Numerous types of classification of metastatic lesions exist, among which the Tomita system, based on MRI findings, appears to be the most practical. The aim of this paper is to present the current incidence of different morphological types of metastases as classified by the Tomita system.

MATERIALS AND METHODS

This work was based on cases treated at the Department of Oncological Orthopaedics of the Specialist Hospital in Brzozów - Podkarpacie Oncological Centre from 2010-2015. A total of 854 patients with spinal metastases were hospitalised at the department. All patients underwent a CT and MRI of the spine and their metastatic lesions were classified as one of the 7 types described by Tomita. The incidence of different morphological types of metastases per type of the primary tumour was also determined.

RESULTS

Most patients treated at the department had advanced disease as a result of diagnostic delays. Types T3-T7 were found in 91% of the patients and T7 in 44%. The highest incidence of advanced disease was seen among patients with breast cancer and myeloma. Higher pain severity and incidence of neurological complications were noted in patients with multisite lesions. Neurological deficits were diagnosed in 228 patients, of whom 68% were classified as Type T6 or T7. Most of the T6/T7 patients were unable to walk unassisted and required constant help from their family or medical staff.

CONCLUSIONS

The Tomita system allows for easy and clear classification of the morphology of malignant metastases. 66% of patients treated at our department had multisite T6 or T7 metastases.