Metastatic Spine Disease: Relieving Pain and Protecting Your Mobility
When cancer spreads to the spine, the goals are clear: control pain, protect the spinal cord and keep you walking and doing the things that matter to you. Today’s treatments, from focused radiation to minimally invasive surgery, make those goals achievable for many patients.
What Is Metastatic Spine Disease?
Metastatic spine disease means cancer that started somewhere else in the body has spread (metastasized) to the spine. The spine is the most common place for cancer to spread to bone. Metastases usually start in the vertebral bodies, the front part of the spinal bones, and can weaken the bone or grow into the spinal canal and press on the spinal cord or nerves.
Breast, lung, prostate, kidney and thyroid cancers, along with multiple myeloma, are the most common sources. Sometimes back pain from a spinal metastasis is the first sign of cancer.
Symptoms
Common symptoms
- Back or neck pain that is constant and gets worse over time
- Pain that is worse at night or when lying flat
- Pain that worsens with movement, which can be a sign of an unstable spine
- Pain, numbness or tingling traveling into the arms, chest wall or legs
Symptoms patients often ignore
- New back pain in anyone with a history of cancer, even years after treatment
- Pain that wakes you from sleep
- Leg heaviness or a change in walking
- Unexplained weight loss or fatigue
When it’s an emergency: New leg weakness, numbness in the groin, or bladder or bowel changes can mean the spinal cord is being compressed (spinal cord compression). This needs treatment within hours. Call 911 or go to the nearest emergency room.
Risk Factors
- A current or past diagnosis of cancer, especially breast, lung, prostate, kidney or thyroid cancer
- Multiple myeloma or lymphoma
- Advanced-stage cancer
How We Diagnose Metastatic Spine Disease
- MRI of the whole spine with contrast: shows all areas of involvement and any pressure on the spinal cord
- CT scan: shows how much bone is destroyed and whether the spine is stable
- Bone scan or PET scan: looks for cancer elsewhere in the skeleton and body
- Biopsy: when the type of cancer isn’t already known
Treatment Options
Treatment is planned together with your oncology team and is based on four key questions: Is the spinal cord compressed? Is the spine stable? How sensitive is the cancer to radiation? And what is your overall health and outlook?
Non-surgical treatment
- Radiation therapy: the main treatment for many spinal metastases; stereotactic radiation delivers high, precise doses that control many tumors that used to resist standard radiation
- Systemic therapy: chemotherapy, hormone therapy, targeted therapy or immunotherapy, depending on the cancer
- Steroids: to reduce swelling around the spinal cord
- Bone-strengthening medications and pain control
When surgery makes sense
Surgery is recommended when tumor is compressing the spinal cord, when the spine is unstable or a vertebra has collapsed, when pain is severe and mechanical, or when the cancer doesn’t respond to radiation. In these situations, surgery can often correct the problem and help patients stay on their feet. Options include:
- Decompression and stabilization: removing tumor from around the spinal cord and stabilizing the spine with screws and rods, often followed by stereotactic radiation (“separation surgery”)
- Minimally invasive stabilization: screws placed through small incisions, allowing faster recovery and a quicker return to cancer treatment
- Kyphoplasty and vertebroplasty: bone cement injected into a fractured vertebra to relieve pain
- Vertebral corpectomy: removing and rebuilding a vertebra destroyed by tumor
Why Choose Dr. Betsy Grunch for Metastatic Spine Disease
- Duke-trained: neurosurgical residency and spine research fellowship at Duke University School of Medicine, where she received the Spine Young Investigator Award
- Experience you can count on: in practice since 2013, performing 400 to 600 surgeries a year and more than 5,000 procedures over her career
- Team approach: she works closely with your oncologists so surgery fits into your overall cancer care, with minimally invasive options to get you back to treatment sooner
- The right treatment for you: board-certified (FAANS, FACS, FCNS), she starts with the least invasive option that will work, and recommends surgery when it can correct the problem
- Clear answers: known online as Ladyspinedoc, she makes sure you understand your imaging and every option in front of you
What to Expect If You Need Surgery
Before surgery
You’ll meet with Dr. Grunch or one of her physician assistants to review your imaging and talk through your goals. Our team coordinates closely with your oncologists and arranges any testing you need.
Procedure day
Kyphoplasty is often done as an outpatient procedure. Decompression and stabilization typically involve a hospital stay of several days.
Recovery timeline
- Days 1-3: up and walking with help; many patients notice pain relief quickly
- Weeks 2-4: wound healing; radiation and other cancer treatment usually resume once the incision has healed
- Weeks 6-12: physical therapy and gradual return to activities
- Ongoing: regular imaging to monitor the spine
Frequently Asked Questions
Does cancer in my spine mean I will be paralyzed?
No. Most patients with spinal metastases never develop paralysis. Recognizing early warning signs and treating spinal cord compression promptly protects walking.
Why would surgery be recommended if I have advanced cancer?
Surgery can relieve pain, protect the spinal cord and stabilize the spine, which helps patients stay independent and continue their cancer treatment.
Is radiation enough?
For many patients, yes. Surgery is added when the spine is unstable, the spinal cord is compressed, or the tumor doesn’t respond to radiation.
Will surgery delay my cancer treatment?
Usually only briefly. Minimally invasive techniques help patients heal faster and get back to treatment, often within a few weeks.
What is kyphoplasty?
A minimally invasive procedure that injects bone cement into a fractured vertebra to relieve pain and support the bone, usually through a needle in the back.
Take the Next Step
Learning that cancer has spread to your spine is frightening. Whether you need a diagnosis, a treatment plan or a second opinion, Dr. Grunch and the Southern Neurosurgery team are here to help you understand your options.
Call 470-293-9800 to schedule an appointment or contact us online.
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We see patients across metro Atlanta and North Georgia at our offices in Gainesville, Sandy Springs and South Atlanta (Riverdale). Find the office nearest you.
This page is for educational purposes only and is not a substitute for medical advice. If you have sudden weakness, numbness in the groin, or bladder or bowel changes, call 911 or go to the nearest emergency room.