Correspondence (reply): In Reply

The many constructive readers’ letters, which cannot all be reproduced here, emphasize again the importance of treating spinal metastases in everyday clinical practice.

Computed tomography undoubtedly provides information about the bony structures, as mentioned by Professor Späth-Schwalbe and Dr Gossner. However, from an orthopedic perspective, magnetic resonance imaging allows for better differentiation of inflammatory processes and a more precise exposure of soft tissues in the spinal canal. So as not to have to obtain two tomograms, it is therefore MRI that is recommended in routine clinical practice. Whether the so called “involvement of the posterior edge” mentioned above is a contraindication for kyphoplasty is currently still the subject of controversial discussion in the literature (1). In case of doubt, CT will certainly allow a better estimate of the surgical risk. Adding useful laboratory investigations (serum calcium, electrophoresis, PSA, differential blood count) in skeletal metastases is important, as is the mention of the negative szintigram in multiple myeloma; we did not include these in our article for reasons of space.

For the same reasons we did not include any great detail about the importance of dentists helping to prevent jaw osteonecrosis in patients taking bisphosphonates. With regard to the frequency of osteonecrosis, we wish to mention that in our experience, especially of hematological oncology, the maximum incidence is strictly in single figures. The cited study, which was recently published in the Lancet (2), investigated the use of zolendronic acid versus clodronic acid in multiple myeloma and describes the frequency of jaw osteonecrosis in a region of <1% up to a maximum of 4%.

Radionuclide therapy, as mentioned by the colleagues from Dresden, is a good treatment option in patients with diffuse bone metastases for the treatment of metastasis related pain and should indeed not be forgotten.