Physiatric management of patients with metastatic disease of the spine.

The specialist in physical medicine and rehabilitation, joining with medical and surgical colleagues, can contribute special skills to both the diagnosis and management of complications related to neoplastic diseases and their treatment. The multifaceted team approach-lending the skills of the physiatrist and the physical, occupational, and speech therapists as successfully employed in the rehabilitation of chronic neuro-musculoskeletal disability-can with equal facility be utilized in the management of the cancer patient. Although in these instances the rehabilitative goals of caring for patients with spinal metastatic disease may remain essentially the same, treatment time is often telescoped by progressive disease requiring frequent accommodation to the staging of functional levels of locomotion and self-care. The direct or remote effects of the cancer itself; the residual effects of radical surgery, and the toxic side effects of chemoprophylaxis and radiotherapy, combined with a sympathetic understanding of the dying process, individually or collectively are challenges the physiatrist has to master to become a productive member of the oncology treatment team. In this role the physiatrist can bring to bear his or her considerable diagnostic expertise in the neuro-musculoskeletal clinical and electroneuromyographic evaluation of spinal pain and weakness syndromes as well as their treatment. Realistic expectations, tempered by a knowledge of the natural history of the specific malignancy and the presence of associated comorbidities of pain, asthenia, and weakness, separately and together can influence the rehabilitation effort to restore patients to their fullest psychological, social, vocational, physical, avocational, and educational potential.1.