Metastatic Lesion in Thoracic and Lumbar Vertebrae: Diagnosis and Treatment
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This assignment discusses the diagnosis and treatment of metastatic lesion in thoracic and lumbar vertebrae. It explores the symptoms, pain assessment, and treatment options including chemotherapy, surgery, and radiation therapy.
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Assignment NameStudent ID Assignment Name Student ID Course Name 23 Mar 2019 1|P a g e
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Assignment NameStudent ID Answer 1 Metastatic lesion in thoracic and lumbar vertebrae is a spinal disease which affects the neurologic condition. Back pain is the most common symptom which is elevated by weeks (Suzuki et al., 2017). In the present case, David is suffering from tumour- related pain which may be exacerbated which movement and increase the load on theaxialspine.Theassociatedpainismediatedbyinflammationandtumour stretching in the periosteum of the vertebral body. In this case, radiculopathy causes band-like pain which results from neural foraminal compression in lumbar vertebrae (Serak, Vanni & Levi, 2015). Radiculopathy in the lumbar spine is also responsible for weakness in the upper and lower extremities. Correct diagnosis of neurological symptoms pain assessment with ASIA score is necessary for appropriate treatment. Also, MRI scanning is required do access metastatic bone tumours which might mimic nerve root pain (Sebro et al., 2017). The treatment approach for metastatic spine tumours generally includes chemotherapy, surgery, and radiation therapy. Answer 2 2a. NSAIDs are commonly used for pain management in metastatic cases, however, itshouldbeprescribedweightcarefulconsideration.NotethatNSAIDsasan analgesic for this case should be used only to manage moderate pain. Cox-2 inhibitor is especially useful in case of bone pain. Acetaminophen is an effective analgesic but with week anti-inflammatory action. Ketorolac can be equally useful for relieving pain, but it should not be prescribed for continuation beyond five days, due to high toxicity. Also, important is that NSAIDs can cause renal insufficiency. NSAID Cox-2 inhibitors like meloxicam and celecoxib are important to avoid ulcer and gastric side effect (Figura, Smith, & Yu, 2018). 2b. For bone-related pain management, in accordance with the guideline of WHO, step 1 must include usage of NSAIDs, as it aims to reduce mild pain (Brogan & Odell, 2016). Step 2 is concerned to use initial intense pain with the weak opioid. Further, step 3 is to control intense pain with stronger opioids. Keeping a view of the MRI reports and persistent pain, opioid analgesics are of high effectiveness. In the present case, to reduce the bone pain, immediate release and short-acting opioid are of high choice for management of the condition. Immediate-release opioids such 2|P a g e
Assignment NameStudent ID as hydromorphone, oxymorphone, morphine, and oxycodone will be highly efficient to reduce the pain alleviation. In case of pain severity, fentanyl will be effective in combination with sustained-release morphine or oxycodone. However, care should be given to counteract the side effects of nausea and constipation (Frost, Hansen & Heegaard,2016).Prochlorperazinecouldbeeffectivetominimizethenausea symptoms. References: Brogan, S. E., & Odell, D. W. (2016). Pain Management in Metastatic Bone Disease. InMetastatic Bone Disease, 1,155-168 Figura, N., Smith, J., & Yu, H. H. M. (2018). Mechanisms of, and adjuvants for, bone pain.Hematology/Oncology Clinics,32(3), 447-458. Frost, C. Ø., Hansen, R. R., & Heegaard, A. M. (2016). Bone pain: current and future treatments.Current opinion in pharmacology,28, 31-37. Sebro, R., DeLaney, T. F., Hornicek, F., Schwab, J., Choy, E., Nielsen, G. P., & Rosenthal, D. I. (2017). Frequency and risk factors for additional lesions in the axial spine in subjects with chordoma: indications for screening.Spine,42(1), E37-E40. Serak, J., Vanni, S., & Levi, A. D. (2015). The extreme lateral approach for treatment of thoracic and lumbar vertebral body metastases.Journal of neurosurgical sciences. Suzuki, T., Katagiri, H., Noda, T., Ota, S., Murata, H., Wasa, J., ... & Takahashi, M. (2017).Asymmetricalvertebralcollapsefromspinalmetastasisinlower thoracic and lumbar spine.Journal of Orthopaedic Science,22(3), 405-410. 3|P a g e