Spinal carcinomatous metastases. Retrospective study of 67 surgically treated cases

Surgical indications and prognosis in spinal metastases

Based on the catamnestic evaluation of our own case material and the compilation of recent series from the literature, the indication for surgical intervention in spinal metastases is considered in the light of factors influencing the prognosis of the underlying malignant disease.

Surgical management of vertebral neoplasia: who, when, how and why?

To determine the role of surgery in vertebral neoplasia, we conducted a retrospective review of patients undergoing surgery for vertebral neoplasia in the Royal Orthopaedic Hospital, Birmingham, and Coventry and Warwickshire Hospital, Coventry. Surgery included decompression, stabilisation or both. The neurological status was assessed by Frankel grading before and after surgery. Of 70 patients undergoing surgery, 14 were neurologically intact preoperatively, and a further 25 were weak but ambulatory. Following surgery, 35 were intact, and a further 22 were ambulatory. Sixty-six patients (94%) obtained good pain relief. Survival correlated with histology and younger age at presentation, but not with level, neurology at presentation or type of surgery. We conclude that neurological status, pain relief and mechanical stability are better after appropriate surgery than after radiotherapy or inappropriate surgery. Failure to consider the surgical option may deny the chance of significant neurological recovery.

Indication for surgery of spinal metastases within the cervical region

A 40-year-old female patient developed a nearly complete tetraparesis within two weeks. Neurological examination showed nearly complete tetraparesis, complete sensory impairment from the level of C4 and hyperreflexia of tendon jerks. Radiological examination showed a space occupying lesion with an extraspinal extension. Operative decompression was carried out and the patient recovered completely within 3 months.