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Renal cell carcinoma is among the 10 most common cancers. Metastatic disease of the spine is common and 50% of bone metastases are already present at the time of primary diagnosis. Bone metastases from renal cell carcinoma are difficult to manage, especially vertebral localization. A 48-year-old woman was diagnosed with renal cell carcinoma in the context of low back pain. The patient presented two skeleton metastases at diagnosis (T11 and 5th rib). The patient received neoadjuvant treatment with cabozantinib, followed by removal of the renal tumor. Radiotherapy was administered for the lumbar lesion. In spite of the radiotherapy treatment, increased low back pain limiting mobility and ambulation. MRI showed an occupation of the spinal canal, without neurological lesion. The SINS scale revealed a score of 14 (vertebral instability). The patient's prognosis was greater than 12 months according to the Tokuhashi score. Based on clinical and mechanical criteria, surgical treatment of the vertebral lesion was decided. T11 vertebrectomy was performed, the reconstruction was made with an expandable cage, and T8 a L2 posterior spinal arthrodesis. A partial resection of the fifth rib was performed in order to remove the whole macroscopic tumor. After 3 months, she was diagnosed with a local infection, treated by irrigation, debridement and antibiotherapy, with good evolution. At 1-year follow-up, she has no low back pain or functional limitation. Follow-up chest-abdomen-pelvis computed CT scan showed absence of disease progression, furthermore, the vertebral arthrodesis shows fusion signs. At the time of this report, there are no clinical or radiological data of infection.
Cho, J.H. Ha, J.K. Hwang, C.J. Lee, D.H. & Lee, C.S. (2015) Patterns of Treatment for Metastatic Pathological Fractures of the Spine: The Efficacy of Each Treatment Modality. Clin Orthop Surg; 7(4):476-82, https://doi.org/10.4055/cios.2015.7.4.476
Giehl, J.P. & Kluba, T. (1999) Metastatic spine disease in renal cell carcinoma indication and results of surgery. Anticancer Res; 19(2C):1619-23.
Joaquim, A.F. Powers, A. Laufer, I. & Bilsky, M.H. (2015) An update in the management of spinal metastases. Arq Neuropsiquiatr. 73(9):795-802. https://doi.org/10.1590/0004-282X20150099
Langdon, J. Way, A. Heaton, S. Bernard, J. & Molloy, S. (2009) The management of spinal metastases from renal cell carcinoma. Ann R Coll Surg Engl; 91(8):649-52, https://doi.org/10.1308/003588409X432482
Laufer, I. Lorgulescu, J.B. Chapman, T. Lis, E. Shi, W. Zhang, Z. Cox, B.W. Yamada, Y. & Bilsky MH. (2013) Local disease control for spinal metastases following "separation surgery" and adjuvant hypofractionated or high-dose single-fraction stereotactic radiosurgery: outcome analysis in 186 patients. J Neurosurg Spine; 18(3):207-14, https://doi.org/10.3171/2012.11.SPINE12111
Laufer, I. Rubin, D.G. Lis, E. Cox, B.W. Stubblefield, M.D. Yamada, Y. & Bilsky, M.H. (2013) The NOMS framework: approach to the treatment of spinal metastatic tumors. Oncologist; 8(6):744-51, https://doi.org/10.1634/theoncologist.2012-0293
Les, K.A. Nicholas, R.W. Rougraff, B. Wurtz, D. Vogelzang, N.J. Simon, M.A. & Peabody, T.D. (2001) Local progression after operative treatment of metastatic kidney cancer. Clin Orthop Relat Res. (390):206-11, https://doi.org/10.1097/00003086-200109000-00023
McLaughlin, JK. & Lipworth, L. (2000) Epidemiologic aspects of renal cell cancer. Semin Oncol; 27(2):115-23.
Mendel, E. Bourekas, E. Gerszten, & P. Golan, J.D. (2009) Percutaneous techniques in the treatment of spine tumors: what are the diagnostic and therapeutic indications and outcomes?. Spine; 15;34(22Suppl):S93-100, https://doi.org/10.1097/BRS.0b013e3181b77895
Ortiz-Cruz E. & Ramos-Pascua L.R. (2020). Manual de tumores óseos SECOT. 1 ed. Madrid. Fundación SECOT.
Smith, E.M. Kursh, E.D. Makley, J. & Resnick, M.I. (1992) Treatment of osseous metastases secondary to renal cell carcinoma. J Urol; 148:784-7, https://doi.org/10.1016/s0022-5347(17)36719-8
Tokuhashi, Y. Matsuzaki, H. Oda, H. Oshima, M. & Ryu, J. (2005) A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis. Spine; 1;30(19):2186-91, https://doi.org/10.1097/01.brs.0000180401.06919.a5
Tomita, K. Kawahara, N. Baba, H. Tsuchiya, H. Nagata, S. & Toribatake, Y. (1994) Total en bloc spondylectomy for solitary spinal metastases. Int Orthop; 18(5):291-8, https://doi.org/10.1007/BF00180229
Tomita, K. Kawahara, N. Kobayashi, T. Yoshida, A. Murakami, H. & Akamaru, T. (2001) Surgical strategy for spinal metastases. Spine; 1;26(3):298-306, https://doi.org/10.1097/00007632-200102010-00016
Umer, M. Mohib, Y. Atif, M. & Nazim, M. (2018) Skeletal metastasis in renal cell carcinoma: A review. Ann Med Surg (Lond); 31;27:9-16, https://doi.org/10.1016/j.amsu.2018.01.002