Metastatic spine oncology: symptom-directed management

Hypercalcemia-Associated Hodgkin's Lymphoma Presenting as Normal Pressure Hydrocephalus: A Case Report

Hodgkin's lymphoma is a malignancy of the lymphatic system that can rarely present with advanced-stage features such as spinal cord involvement and hypercalcemia. We present the case of a 63-year-old Caucasian male with advanced Hodgkin's lymphoma, presenting with hypercalcemia and symptoms resembling normal pressure hydrocephalus. The patient exhibited gait impairment, altered mental status, and urinary incontinence, forming the classic triad seen in normal pressure hydrocephalus. Laboratory findings revealed leukocytosis, anemia, hypercalcemia, and acute kidney injury. Imaging showed extensive lymphadenopathy, a right adrenal mass, and bone marrow abnormalities suggestive of disseminated malignancy, leading to the decision not to biopsy the adrenal mass due to the strong suspicion of widespread metastatic disease. A biopsy of a mediastinal lymph node confirmed the diagnosis of Hodgkin's lymphoma, with hypercalcemia attributed to paraneoplastic syndrome. The patient's treatment included managing hypercalcemia and administering chemotherapy with adriamycin, bleomycin, vinblastine, and dacarbazine. This case highlights the importance of considering Hodgkin's lymphoma in patients with atypical presentations and the need for comprehensive diagnostic evaluation, including imaging and laboratory tests. While hypercalcemia in Hodgkin's lymphoma is associated with a poor prognosis, newer therapies like brentuximab vedotin offer promising treatment options for frail patients.

Management of Metastatic Spinal Disease - A Practical Approach

STUDY DESIGN

Narrative review.

OBJECTIVE

This review presents a comprehensive approach to the management of spinal metastases.

METHODS

N/A.

RESULTS

The wide spectrum of clinical presentation in spinal metastases necessitates a personalized approach to treatment planning. This includes a comprehensive diagnostic workup, oncological management, palliation of symptoms, and surgical intervention if appropriate. A systematic and multidisciplinary approach allows optimal shared decision making to reach an evidence-informed and value-congruent treatment plan for the patient. We highlight how advances in stereotactic body radiotherapy (SBRT) and separation surgery may be incorporated into clinical management from a spine surgeon's perspective.

CONCLUSION

This review summarizes the approach and management of spinal metastases, its outcomes and complications.

Rehabilitation in Advanced Cancer Patients with Bone Metastases and Neural Compromise: Current Status and Future Directions

PURPOSE OF REVIEW

This review aimed to increase the understanding of oncologists and physiatrists about the necessity, efficacy, and safety of rehabilitation in advanced cancer patients with bone metastases and neural compromise.

RECENT FINDINGS

Recently, there are growing evidence supporting the safety and efficacy of rehabilitation in patients with bone metastases and neural compromise. Despite the potential benefits of rehabilitation, however, rehabilitative services are considerably underutilized in clinical practice. Many oncologists are not familiar with functional issues and have limited understanding of the available rehabilitative services. Moreover, medical professionals, even physiatrists, have uncertainties and concerns about skeletal complications and often regard rehabilitation as a contraindication in this patient group. This review aimed to raise awareness on the role of rehabilitation in the continuum of cancer treatment, to improve its use in clinical practice. A multidisciplinary team approach involving physiatrist may facilitate integration of relevant clinicians.