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Metastases - Long Bone and Spine

General

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What are the common mets to spine/ bone? (what to examine)

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Which mets are typically blastic?

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What investigations?

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Special investigation for Spine Mets?

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What is the pathophysiology of metastasis?

SPINE METS

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How will you assess this patient with suspected Spine Mets? #📜

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How much bone involvement must there be to be seen on XR?

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What is the difference in MRI for Infection vs Tumor vs TB?

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What is the pathogenesis of Hematogenous spread mets/ infection/ TB to spine? Usually which part affected first?

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What is your initial management for spine mets?

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What is your definitive management? Any framework?

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How do you assess the Neurological component?

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How do you assess the Oncologic component?

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How do you assess the Mechanical component?

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How do you assess the Systemic component?

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What tumors will you consider Pre-op angioembolization?

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Any landmark paper for Spinal mets?

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What approaches?

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Management of Oligometastatic disease?

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What is SBRT?

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What is separation surgery?

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How to reduce wound complications post op?

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Aware of PEEK and carbon implants?

LONG BONE METS

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What is the Mirel's score?

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What scenarios?

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Role of frozen section?

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Special technique for nails?

CASE: PATHOLOGICAL FRACTURE

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How will you evaluate and manage this patient if no history of cancer?

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How will you evaluate this patient with history of cancer but unknown mets?

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How do you manage this fracture after workup?

Case: Open pathological fracture

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What are your considerations and approach to open pathological fracture?

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1. Treat open fracture

2. Ex fix for temporary stability while waiting for definitive treatment
3. Complete work up after ex fix- local and systemic staging

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4. MDT to decide curative or palliative