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Failure of the spine's structural integrity from metastatic disease can lead to both pain and neurologic deficit.
Fractures that require treatment occur in over 30% of bony metastases. Our objective is to use computed
tomography (CT) in conjunction with analytic techniques that have been previously developed to predict fracture
risk in cancer patients with metastatic disease to the spine. Current clinical practice for cancer patients with spine
metastasis often requires an empirical decision regarding spinal reconstructive surgery. Early image-based software
systems used for CT analysis are time consuming and poorly suited for clinical application. The Biomedical Image
Resource (BIR) at Mayo Clinic, Rochester has developed an image analysis computer program that calculates from
CT scans, the residual load-bearing capacity in a vertebra with metastatic cancer. The Spine Cancer Assessment
(SCA) program is built on a platform designed for clinical practice, with a workflow format that allows for rapid
selection of patient CT exams, followed by guided image analysis tasks, resulting in a fracture risk report. The
analysis features allow the surgeon to quickly isolate a single vertebra and obtain an immediate pre-surgical multiple
parallel section composite beam fracture risk analysis based on algorithms developed at Mayo Clinic. The analysis
software is undergoing clinical validation studies. We expect this approach will facilitate patient management and
utilization of reliable guidelines for selecting among various treatment option based on fracture risk.
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