Spinal metastases from renal cell carcinoma: Case note with an overview

Abstract

Background: Metastases to spine from renal cell carcinoma is challenging to manage as they are chemo and radioresistant along with being rapidly expansile and extremely hyper vascular. Also, they continue to cause pain and may result in cord compression leading to subsequent neurodeficit. Total en-bloc resection remains the gold standard surgical intervention but is associated with increased morbidity. Hence, posterior decompression and fixation has been the current standard of surgical care. However, considering the risk of massive blood loss in renal cell carcinoma, pre-operative embolization within 48 h of surgery is recommended. Vertebroplasty has been described for stabilization of osteoporotic compression fractures as well as for metastatic vertebral body lesions. It offers both pain relief and anterior column support which may be lacking with posterior fixation.Case Description: The authors describe a 26-year-old paraplegic female with grade 4 renal cell carcinoma having metastatic deposits to dorsal spine with cord compression. She underwent pre-operative embolization 36 h prior to surgical intervention, which included vertebroplasty, decompression and posterior fixation with screws/rod. Conclusion: Preoperative embolization decreases the risk of intraoperative haemorrhage in hyper vascular spinal metastases such as renal cell carcinoma. Vertebroplasty as an adjuvant to posterior surgical stabilisation is becoming a standard of care for palliative pain control associated with pathological vertebral compression fractures as it also provides an anterior column support helping in early ambulation. Also, Fuhrman’s grading can be relied upon as an independent prognostic factor.