THE FUNCTION OF THE VERTEBRAL VEINS AND THEIR ROLE IN THE SPREAD OF METASTASES

METASTATIC ABSCESSES and metastatic tumors can appear in locations that do not seem to be in line of direct spread from their primary focus. There is even a regularity of distribution of these paradoxic metastases. Empirically, the roentgenologist makes a diagnosis of primary carcinoma of the prostate when he finds a certain peculiar distribution of bone lesions in the pelvis. Adequate explanation has not been forthcoming for. the typical and peculiar distribution of these metastatic lesions. The pattern, to me, is not at all that of the nerve sheaths of the area as suggested by Warren, et al.1 It is not the pattern of lymph vessel distribution. The only anatomic system into which this pattern fits is the system of veins which, in its plexiform ramifications, infiltrates and invests the sacrum, the lumbar spine, and the adjacent wings of the ilia. Several years ago, I suggested that the architecture of this plexus of veins could be explored by taking advantage of the pelvic anastomoses of the deep dorsal vein of the penis. The connections and the collateral circulations of this vein are identical with those of the prostatic plexus of veins with which it connects. Valves in the veins of this region are exceedingly variable. All valves present permit flow toward the sacral venous plexus. Injections were first made in I937. A preliminary report was read before the Conference of Eastern Radiologists, in Philadelphia, January 29, I938, under the title of "The Veins of the Sacrum in Relation to Metastatic Carcinoma from the Prostate." This work has been continued and extended. Injections and corrosion preparations of the vessels of the head and neck, already completed, formed an invaluable background for this study. The dissemination of infections and tumors from organs in other regions by the veins about the spine has also been considered. This has led to a better appreciation of the role of the vertebral veins in normal physiology.