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Spinal Surgery May Help Breast Cancer Patients With Bone Pain (dateline May 19, 2000)

Breast cancer has the potential to spread ( metastasize) past the breast into other regions of the body. According to British researchers, breast cancer is more likely than any other type of cancer to spread to the spine, causing severe bone pain, yet the majority of breast cancer patients do not receive spinal surgery that can significantly relieve this pain.

In the study published in the Journal of Bone and Joint Surgery, researchers followed 963 women who had been diagnosed with breast cancer seven years earlier. Approximately 44% of the women had experienced bone pain at some point during their struggle with breast cancer. However, only six of the 51 women whose cancer had spread to the spine had received surgery for their destabilized spines.

According to lead researcher Charles Galasko, MD, an orthopedic surgeon at the University of Manchester, UK, breast tumors that metastasize to the spine can cause spinal instability. This instability can make even simple body movements painful. Approximately 5% of breast cancer patients experience severe spinal pain and could benefit from spinal surgery.

Spinal surgery, according to the researchers, helps stabilize the spine and relieve compression of the vertebrae and nerves. Galasko and his colleagues have performed the surgery on 80 cancer patients, 40 of whom had breast cancer. Nearly 90% of the patients reported complete pain relief after the surgery. The most common side effect of the spinal surgery reported by the researchers was infection.

Because bone deterioration from spinal instability does not occur from the cancer itself, but from bone deterioration, the researchers say conventional cancer treatment with chemotherapy or radiation therapy cannot alleviate spinal pain. However, breast cancer patients should wait until they have had time to heal from standard treatment before undergoing spinal surgery.

Spinal surgery (also called spinal instrumentation) can be performed a variety of different ways using rods, plates or screws. Patients are usually considered for spinal surgery after conventional ways of treating spinal pain are exhausted (such as physical therapy or back bracing). One new type of spinal procedure that is being used more often to treat spinal back due to tumors is called vertebroplasty.   Vertebroplasty involves injecting a special liquid cement into fractured vertebral sections. The procedure is minimally invasive and can significantly reduce spinal pain caused by cancer or osteoporosis.

In one case, vertebroplasty was performed on a metastatic breast cancer patient who had previously undergone both chemotherapy and radiation therapy .  The cancer had spread to her spine, causing severe pain and paralysis from spinal cord compression. Originally, surgeons planned to use metal rods to stabilize the spine, but fear of further vertebral body collapse caused them to consider vertebroplasty instead. After vertebroplasty was performed, steroids were administered, eliminating her paralysis and allowing her to leave the hospital almost immediately.

Researchers encourage communication between all physicians and health care professionals involved in a patient’s breast cancer treatment. Orthopedic surgeons and/or neuroradiologists should work with oncologists and physicians to determine if and when spinal surgery is necessary.

In addition to the spine, breast cancer has the potential to spread to any region of the body. The bone, lung, and liver are the most common regions to which breast cancer may spread. Though less common, breast cancer may infect the bone marrow, brain, ovaries, eye, and other areas. The treatment of metastatic breast cancer (cancer that has spread past the breast and underarm lymph nodes) is often more involved and less successful than the treatment of early- stage, confined cancer.