METASTATIC MALIGNANCY OF THE SPINE

¹ Department of Bone and Joint Surgery, The Lahey Clinic, Boston

1. Roentgenograms of the spine should be taken in all cases of persistent back pain, even when symptoms are mild. If the clinical diagnosis of spinal metastasis is made, roentgenotherapy should be employed, even if roentgenograms are negative.

2. Roentgenotherapy is the most valuable means at our disposal for relief of pain in metastatic malignancy of the spine.

3. The results achieved with cobra venom have been disappointing.

4. For intractable pain in the low back, lower extremities, and pelvis, subarachnoid injection of alcohol is useful, although there is the risk of injury to the spinal cord.

5. Chordotomy is the method of choice for patients whose general condition and prognosis for length of life warrant a surgical procedure. The results are more certain and satisfactory than those obtained by subarachnoid injection of alcohol.

6. Orchectomy is of value in carcinoma of the prostate because of the clinical improvement in cases so treated. It is as yet too early to report the end results of this treatment.

7. Salicylates and codeine were used in the earlier stages, and dilaudid was preferred in the later stages for the control of pain. Chronic back pain unrelieved by recumbency, salicylates, and codeine is usually the pain of cancer.

8. Braces help to relieve back pain in some patients with vertebral compression.

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