Current Concepts Review   |    
Current Concepts Review. Spinal Instability Secondary to Metastatic Cancer*†
C. S. B. Galasko, M.Sc., Ch.M., F.R.C.S., F.R.C.S.E.‡; Heather E. Norris, B.A., R.G.N.‡; Stella Crank, M.Sc.‡
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Investigation performed at the University of Manchester, Manchester, United Kingdom
*No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. Funds were received in total or partial support of the research or clinical study presented in this article. The funding source was the National Health Service North West Regional Research and Development Fund.
†Read in part at the Combined Meeting of the Orthopaedic Associations of the English-Speaking World, Auckland, New Zealand, February 4, 1998.
‡Clinical Division One (Orthopaedic Surgery), University of Manchester, Clinical Sciences Building, Hope Hospital, Eccles Old Road, Salford M6 8HD, Manchester, United Kingdom.

J Bone Joint Surg Am, 2000 Apr 01;82(4):570-570
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Intractable back pain is a frequent symptom of disseminated cancer, and in patients who have spinal metastases the pain is related to spinal instability13. The spinal instability is mechanical and is related to extensive bone destruction due either to tumor-mediated osteolysis or to iatrogenic causes, and the pain is due to vertebral fracture. Cancer of the breast is the most common primary tumor associated with metastases to the spine (Table II)17. However, any tumor can metastasize to the spine and produce sufficient destruction to render the spine unstable, leading to excruciating pain that is induced by mechanical instability and to spinal-cord or nerve-root compression resulting in paresis. When the pain is excruciating, the patient is comfortable only when lying absolutely still. Any movement, including log-rolling (even by two or three trained nurses), is associated with agonizing pain, and the patient may not be able to sit, stand, or walk because of the pain, even with use of a spinal orthosis. When the spine is minimally involved, the patient may be relatively free of pain when wearing a rigid spinal orthosis, but any movement of the back (for example, turning in bed, sitting, or standing) may be impossible without the orthosis.
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