Sternal metastasis - the forgotten column and its effect on thoracic spine stability
Piggott, Robert Pearse Curtin, Mark Munigangaiah, Sudarshan Jadaan, Mutaz McCabe, John Patrick Devitt, Aiden
Piggott, Robert Pearse
Curtin, Mark
Munigangaiah, Sudarshan
Jadaan, Mutaz
McCabe, John Patrick
Devitt, Aiden
Publication Date
2017-01-01
Type
Article
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Citation
Piggott, Robert Pearse; Curtin, Mark; Munigangaiah, Sudarshan; Jadaan, Mutaz; McCabe, John Patrick; Devitt, Aiden (2017). Sternal metastasis - the forgotten column and its effect on thoracic spine stability. World Journal of Orthopedics 8 (6), 455-460
Abstract
Sternal metastases are not studied extensively in the literature. There is a paucity of information on their role in metastatic disease. The concept of the fourth column was described by Berg in 1993, and has been proven in case report, clinically and biomechanical studies. The role of the sternum as a support to the thoracic spine is well documented in the trauma patients, but not much is known about its role in cancer patients. This review examines what is known on the role of the fourth column. Following this we have identified two likely scenarios that sternal metastases may impact management: (1) sternal pathological fracture increases the mobility of the semirigid thorax with the loss of the biomechanical support of the sternum-rib-thoracic spine complex; and (2) a sternal metastasis increases the risk of fracture, and while being medical treated the thoracic spine should be monitored for acute kyphosis and neurological injury secondarily to the insufficiency of the fourth column.
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Publisher
Baishideng Publishing Group Inc.
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Attribution-NonCommercial-NoDerivs 3.0 Ireland