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Contemporary Treatment Strategy for Spinal Metastasis: The “LMNOP” System

Published online by Cambridge University Press:  02 December 2014

Gillian R. Paton ,
Evan Frangou  and
Daryl R. Fourney
Gillian R. Paton
Affiliation:
Division of Neurosurgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
Evan Frangou
Affiliation:
Division of Neurosurgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
Daryl R. Fourney*
Affiliation:
Division of Neurosurgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
*
Division of Neurosurgery, University of Saskatchewan, Royal University Hospital, 103 Hospital Drive, Saskatoon, Saskatchewan, S7N 0W8, Canada
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Abstract

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The choice of treatment for spinal metastasis is complex because (1) it depends on several inter-related clinical and radiologic factors, and (2) a wide range of management options has evolved in recent years. While radiation therapy and surgery remain the cornerstones of treatment, radiosurgery and percutaneous vertebral augmentation have also established a role. Classification systems have been developed to aid in the decision-making process, and each has different strengths and weaknesses. The comprehensive scoring systems developed to date provide an estimate of life expectancy, but do not provide much advice on the choice of treatment. We propose a new decision model that describes the key factors in formulating the management plan, while recognizing that the care of each patient remains highly individualized. The system also incorporates the latest changes in technology. The LMNOP system evaluates the number of spinal Levels involved and the Location of disease in the spine (L), Mechanical instability (M), Neurology (N), Oncology (O), Patient fitness, Prognosis and response to Prior therapy (P).

Résumé:

Résumé:

Le choix du traitement des métastases spinales est complexe parce que 1) il dépend de plusieurs facteurs cliniques et radiologiques qui sont inter-reliés et 2) une grande variété d’options thérapeutiques ont été développées depuis quelques années. Bien que la radiothérapie et la chirurgie demeurent la base du traitement, la radiochirurgie et la vertébroplastie percutanée ont maintenant un rôle bien établi. Des systèmes de classification ont été développés pour aider le processus décisionnel et chaque traitement a des forces et des faiblesses différentes. Les systèmes de pointage développés jusqu’à maintenant fournissent un estimé de l’espérance de vie, mais peu de conseils sur le choix du traitement. Nous proposons un nouveau modèle de décision qui décrit les facteurs clé pour élaborer le plan de traitement, tout en reconnaissant que les soins prodigués à chaque patient demeurent très individualisés. Ce système tient également compte des changements technologiques les plus récents. Le système LMNOP évalue le nombre de niveaux spinaux atteints et le Lieu de la maladie dans la colonne vertébrale (L), l’instabilité Mécanique (M), la Neurologie (N), l’Oncologie (O), l’état du Patient, le Pronostic et la réponse aux traitements antérieurs (P).

Type
Review Article
Information
Canadian Journal of Neurological Sciences , Volume 38 , Issue 3 , May 2011 , pp. 396 - 403
Copyright
Copyright © The Canadian Journal of Neurological 2011

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