Metastases in the spine

Metastases in the spine - what does that mean?

Metastases in the bone are a serious complication of cancer. In the case of bone pain, it is therefore important to have the causes clarified at an early stage. In this way, metastases to the spine and vertebral bodies can be detected and treated early. There are ways to inhibit the growth of the metastases and thus stabilize the tumors. The areas of the bones where blood formation takes place provide favorable growth conditions for tumor cells.

The organ to which many cancers preferentially metastasize is - after the liver and lungs - the bones. The spine is the most common site of skeletal metastases, accounting for about two-thirds of all bone tumors. Spinal tumors are thus not uncommon. Predominantly, metastases are located in the thoracic spine and lumbar spine.

The diagnosis of cancer

The diagnosis of cancer is always a shock for the patient. Although modern medicine and researching science have created many possibilities that (some) cancer is curable and the diagnosis no longer basically means death, this disease is still a scourge of mankind. It changes lives and is an incision in everyday life. It makes many sufferers rethink their life expectancy.

Of course, it becomes dramatic when the primary tumor spreads. Cancer cannot only spread to neighboring tissue. Cancer cells tend to spread via blood vessels and lymph vessels to other organs and form metastases there.

Frequency of bone metastases

Granted, it may take a bit of getting used to, but it's true: Metastases are being diagnosed more frequently on the basis of the improved prognosis for a malignant tumor. Ten percent of carcinoma patients have spinal metastases during their disease. Thus, the spread of cancer into the bone tissue is the commonest malignant disease of the bones. Most common are bone metastases in breast cancer, prostate cancer, lung cancer, thyroid cancer, malignant melanoma (black skin cancer), kidney cancer, and multiple myeloma.Thorough autopsy reveals bone metastases in 70 percent of patients who die from cancer. In the 210,000 cancer deaths per year in Germany, 150,000 of them are caused by bone metastases.

Spread of metastases in the body

Daughter tumors, that is the nickname of metastases. The word metastasis itself comes from the Greek and means 'migration'. Metastases are therefore cancer cells on the move.

Some cancer cells leave the tumor, migrate uncontrollably through the body and then settle in the bones. There, these cells are then destructive in the truest sense of the word. They set a competition in motion, so to speak: the battle between bone-degrading and bone-building processes. The cancer cells produce messenger substances (cytokines) and several growth factors. As a result, bone-degrading cells, the so-called osteoclasts, are stimulated more strongly and the balance between bone building and bone formation is disturbed in favor of degradation. The bitter winners are therefore the metastases. The tragic loser is the human being!

Metastases spread throughout the body via two pathways:

  • Via the blood (the so-called hematogenous metastasis).
  • Via the lymphatic channels (the so-called lymphogenic metastasis).

The areas of the bones where hematopoiesis occurs provide favorable growth conditions for tumor cells.

Difference between spinal tumors and vertebral metastases

Spinal tumors can grow in different anatomical locations and are accordingly divided into three categories: Extradural tumors (outside the spinal meninges), intradural-extramedullary tumors (inside the spinal meninges but outside the spinal cord), and intradural-intermedullary tumors (inside the spinal meninges and inside the spinal cord).

Metastases, in turn, originate elsewhere in the body. Thus, they do not usually arise within the spinal column. Rather, cancer cells attach to the vertebral body from the outside and rarely enter the spinal canal. Thus, metastases are extradural daughter tumors.

Brice-McKissock classification


Degree of interference




Patient can walk



Patient can move legs, but not against gravity



Low residual motor and sensory function



No motor and sensory function

Symptoms of metastases to the spine

It is always a single treachery when diseases creep into the body and subsequently no alarm signals are radioed. Then we speak of a creeping process. Fortunately, bone metastases do not have this characteristic! They can be felt, sensed and virtually seen, such as a significant weight loss.

In most cases, pain in the spine is the first symptom of a cancer with bone involvement. Many sufferers describe the pain, which does not improve even when they are at rest, as deep-rooted and difficult to localize. Responsible for this pain are nerve constrictions, reduced blood flow and the release of pro-inflammatory messenger substances.

Motor and autonomic functional limitations are considered the second most common symptoms. 85 percent of patients with spinal metastases suffer from these symptoms. This means: numbness in the extremities, gait disturbances (reduction of strength in the legs), loss of appetite, rapid fatigability, i.e. loss of performance. Often also bladder emptying disorders, increased urination, or inability to hold urine as well as fecal incontinence.

Severity of symptoms of spinal metastases

The symptoms of spinal metastases can be classified into a system, the Brice-McKissock grading, based on their severity. This classification is based on four levels that correspond to the degree of disturbance caused by the metastases. In particular, the motor symptoms are used as a basis.

What you need to consider when diagnosed with metastases of the spine

An informative, accurate diagnosis always begins with a discussion between you and your doctor. You will describe to him where and when you are plagued by which pains, where they radiate.

Through your very personal descriptions, your doctor can already get an idea. However, the picture is not enough for a definitive diagnosis. It is simply that, in addition to the detailed medical history and the clinical examination, the imaging procedures have a special significance. This includes the so-called skeletal scintigraphy (whole-body bone scintigraphy).

If these images show conspicuous foci, further imaging procedures follow. X-rays, computed tomography (CT) and magnetic resonance imaging (MRI) can be used for this purpose. Computed tomography is highly valued with regard to assessing the stability of vertebral bodies. MRI is the tool of choice for assessing extension into the spinal canal.

In fact, the combination of several examination procedures is necessary for a perfect diagnosis. A biopsy of the bone is usually done only when the original, primary tumor is unknown. During a biopsy, doctors remove a sample from the suspicious area.

A positron emission tomography (PET) scan is a whole-body screening method to detect metastases in patients with known carcinoma. PET has strengths, but - when it comes to visualizing surrounding tissue - it also has a few weaknesses.

The complicated therapy of spinal metastases

Spinal metastases usually represent a complex situation in the context of an underlying malignant systemic disease. It is therefore not sufficient for one physician to be responsible for your therapy, but rather a team. This includes specialists in radiation therapy (radio-oncologists), medical oncologists, pain therapists and neurosurgeons! This team considers several aspects in its therapy: the clinical symptomatology (pain/neurology), the spinal stability, the number of spinal metastases, the patient's mobility requirements and the probability in which form the cancer can/will react to radiation or chemotherapy.

Basically, the therapy of spinal metastases is aimed at improving the quality of life by alleviating or eliminating pain and maintaining body functions. The patient's general condition plays an essential role in therapy planning! Not every patient has the strength to endure extensive therapy. This includes, for example, operations to treat fractures and ensure stabilization of the vertebral bodies.

Others are still so strong that they grasp at every famous last straw. Most patients are aware that it is easier for medical professionals to defeat "just" a primary tumor than an entire army of malignant attackers attacking from a wide variety of directions.

Nevertheless, there are a number of effective treatments for bone metastases. The most important and established treatments are radiation, hormone therapy, chemotherapy, bisphosphate therapy, antibody therapy, and surgical therapy. With microsurgery we remove the metastases and - if necessary - the affected segments are stabilized.

Improvement of quality of life and life expectancy

Through neurosurgical interventions with decompression and eventual stabilizing measures - often accompanied by chemotherapy and/or radiotherapy - we improve the quality of life of the affected patients and relieve them from pain to let them be an active part of life - as long as possible. Through neurosurgical interventions with decompression and possible stabilizing measures - often accompanied by chemotherapy and/or radiotherapy - we improve the quality of life of those affected and relieve pain so that patients can participate in life. As long as possible. In the best case, this prolongs the life expectancy of patients with spinal metastases.

Dr. med. Munther Sabarini

Dr. med. Munther Sabarini
Specialist in Neurosurgery

The Avicenna Clinic in Berlin is always willing to help you

Since the year 2001, the Avicenna Clinic is based in Berlin. Our doctors have at least 25 years of international experience in their respective fields (neurosurgery, spinal surgery, anesthesia, and orthopedics).

If you have severe back pain, a herniated disc or a suspected herniation, please contact us using the following information:

Avicenna Clinic
Paulsborner Str. 2
10709 Berlin

Telephone: +49 30 236 08 30
Fax: +49 30 236 08 33 11