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A complete description of the mechanisms and factors involved is outside the scope of this short clinically focused review. Further understanding of the interaction between invading metastasis and surrounding bone cells and factors produced like IL-6, IL-1, TGF-beta and RANK/RANKL have offered chemical therapy in the treatment of painful bone metastasis, especially breast and prostate as known primaries. Commonly, the blood supply to the metastatic nidus comes from pedicular arteries making selective embolization through interventional procedures a viable option. Due to this fact, screw fixation through the involved pedicles often is nonoptimal and requires extending fusion of several segments above and below the lesion. More commonly the tumor spreads backward often involving pedicles, which is an important point of understanding for surgical management of spinal metastasis that would require spinal stabilization. Through an initial interaction between tumors associated factors and intrinsic bone cells like osteoclasts, a nidus of invasion is established. The general spread of metastases involves hematogenous spreading to the center of the vertebral body. The following summary emphasizes the essential knowledge necessary to have while treating patients with spinal metastasis. Among the routes mentioned above, hematogenous spread through Batson’s plexus system is the most common pathway for tumor embolization and spinal invasion. Metastatic diseases to the spine spread through several different routes which include venous hematogenous spread versus the arterial spread, direct tumor extension, and lastly lymphatic spread. This disc space is almost always involved during infection. While evaluating spinal metastasis on MRI imaging, a defining feature of these lesions is the sparing of intervertebral disc space. Within the spinal column, metastasis is more commonly found in the thoracic region, followed by the lumbar region, while the cervical region is the least likely place professionals find metastasis. Spinal metastases are more commonly found as bone metastasis, although they are not limited to bone metastasis, and approximately 20% present with symptoms of spinal canal invasion and cord compression.
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Spinal metastases are the most common tumors of the spine, comprising approximately 90% of masses encountered with spinal imaging.