Minimally Invasive Treatment of Skeletal-Related Events

This chapter aims to provide an overview of the minimally invasive treatment options available for managing skeletal-related events resulting in the context of osteoporotic and pathological (cancerous/metastatic) bones. The impact of oncological treatments on spinal pathology, including long-term corticosteroid therapy-induced osteoporosis, the risk of necrosis associated with radiotherapy, and bone marrow suppression caused by radio-chemotherapy, is discussed. These side effects can lead to the weakening of the spine and lead to spinal fractures. Accurate diagnosis and differentiation of symptoms between fractures and tumors/metastasis are crucial for effective management. Diagnostic methods such as history-taking, clinical examination, and imaging studies including X-ray, CT, MRI (or scintigraphy) play a vital role in precise assessment. Additionally, a diagnostic algorithm is proposed to aid in the evaluation and diagnosis of spinal pathology. Various treatment options are explored, including nonsurgical (conservative) approaches such as pain management, physical therapy, and bracing. Minimally invasive surgical treatments, such as augmentation therapies like vertebroplasty, kyphoplasty, and the OsteoCool™ therapy, are discussed. The option of stabilization/osteosynthesis through spinal fusion, both open and minimally invasive, is considered, along with hybrid surgical options. This chapter highlights the importance of identifying the optimal surgical treatment option, which depends on factors such as the specific condition, patient characteristics, and the expertise of the neurosurgeon. Minimally invasive treatment approaches offer the potential to effectively address skeletal-related events in the context of medical cancer therapy side effects while minimizing patient morbidity and optimizing clinical outcomes.