The Orthobullets Podcast Pathology | Metastatic Disease of Spine
Sep 14, 2025
Delve into the world of metastatic disease of the spine, uncovering its impact and prevalence as a leading cause of bone lesions in adults. Explore the complex mechanisms behind its progression, including the role of osteolysis. Gain insights into symptoms, evaluation strategies, and cutting-edge treatment options. Discover the critical importance of biomarkers and imaging in diagnosis, along with the benefits of a multidisciplinary approach to patient management. This journey through spine oncology is both enlightening and essential for medical professionals.
AI Snips
Chapters
Transcript
Episode notes
Spine Is The Primary Metastatic Site
- The spine is the most common site for bone metastases, with the thoracic spine affected most frequently.
- Proximal femur is the second most common and the leading site for pathologic fracture with high nonunion rates.
Mechanisms Of Bone Destruction And Sclerosis
- Tumor cells drive osteolysis via cytokines (PTHrP, IL-6/11, TGF-β) that stimulate osteoblasts to produce RANK-L and activate osteoclasts.
- Osteoblastic metastases (eg prostate, some breast) result from tumor-secreted endothelin-1 activating osteoblasts and Wnt signaling.
Account For Batson's Plexus
- Evaluate spinal metastasis spread via Batson's valveless vertebral venous plexus as a vascular route from organs to the axial skeleton.
- Consider this anatomy when assessing likely metastatic pathways to vertebral bodies, pelvis, skull, and girdles.