Neurological outcome following laminectomy in spinal metastases.
METHODS
Retrospective outcome measurement study.


OBJECTIVE
Patients suffering from malignant tumour disease and metastases to the spine develop a variety of clinical complaints including radicular symptoms and/or spinal cord compression syndromes. Palliative decompressive laminectomy with total or partial tumour resection is an acknowledged method of treatment, despite controversy.


METHODS
The Department of Neurosurgery of the University of Vienna.


METHODS
Patients suffering from metastases with predominant infiltration of the dorsal epidural parts, or patients who could not be operated on via an anterior approach, were included. Eighty-four patients who met these criteria underwent decompressive laminectomy with total or partial tumour removal. The study analyzed motor function, pain relief and continence in a 2- and 4-month post-operative follow-up. According to the criteria of motor performance, 20% of the patients had been mobile pre-operatively.


RESULTS
In the immediate post-operative period 45%, after 2 months 33% and after 4 months 26%, were considered mobile. None of the paraplegic patients showed functional improvement. The median survival time was 6.5 months. Pre-operatively, 56% of the patients had shown continence dysfunction. Post-operatively, 38%, and after 2 months 46% of the patients, developed continence disorders. A significant reduction in analgesic medication was also observed in the post-operative period.


CONCLUSIONS
In our series, palliative laminectomy with total or subtotal tumour reduction in patients with malignant spinal metastatic disease resulted in amelioration of motor function, pain and continence and therefore improved the patients' quality of life. The improvement in quality of life shows that this method is a valuable option in neurosurgical therapy, except for cases with pre-operative paraplegia. However, in patients with severe pre-operative paraparesis, the authors recommend laminectomy only in very exceptional cases, because of the poor post-operative neurological results.
Schoeggl
A
A
Department of Neurosurgery, University of Vienna, Austria.
Reddy
M
M
Matula
C
C
D000700:Analgesics / Q000627:therapeutic use; D001317:Austria; D000075202:Contraindications; D004363:Drug Utilization / Q000706:statistics & numerical data; D005242:Fecal Incontinence / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D007796:Laminectomy / Q000009:adverse effects; D009043:Motor Activity; D017063:Outcome Assessment, Health Care; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D010166:Palliative Care; D020335:Paraparesis / Q000209:etiology; D011184:Postoperative Period; D011788:Quality of Life; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000209:etiology / Q000601:surgery*; D013125:Spinal Neoplasms / Q000150:complications / Q000556:secondary / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology
D000700:Analgesics