Spinal Mets

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FACTS

 

HPI

 

PHYSICAL EXAM

IMAGING

  1. Find the Blisky Grade
Bilsky Grade
Description
Stenosis Analog
0
no epidural extension bone only
none
1
epidural extension without cord compression
mild
2
cord compression, CSF visible
moderate
3
cord compression, CSF not visible
severe
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MRI w/wo
  • signal varies based on osteoblastic/lytic primary lesion
  • commonly: T1 hypointense, T1+c heterogenously enhancing
A/P
  1. Use NOMS Algorithm to determine need for separation surgery
  1. Surgery
  1. Single fraction / Hypofractionated stereotactic radiation therapy
      2. 💡
      Risks of radiation:
      #1) post-treatment VB fx (4-40%), 16% w/ sypmtomatic fractures
      #other): esophagitis, dermatitis, radiculitis, myelitis (super rare)
NOMS Framework
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