Surgery for solitary metastases of the spine: rationale and results of treatment.
METHODS
A spine tumor database of patients with solitary sites of spine involvement from solid tumors was retrospectively reviewed.


OBJECTIVE
To analyze the long-term survival, neurologic outcome, and results of surgery in a well-defined subset of patients who had spinal metastases with epidural extension to define future treatment strategies.


BACKGROUND
Currently accepted indications for surgical treatment of spinal metastases include histologic diagnosis, neurologic palliation in those who have failed prior irradiation, and spinal stabilization. In all others, external irradiation is considered the mainstay of therapy. Several studies have shown that prior irradiation increases the frequency of complications from surgery and affects functional outcome.


METHODS
A retrospective review of 80 consecutive patients with solitary sites of spine involvement from solid tumors with varying degrees of epidural extension was performed. Complete clinical and radiologic follow-up assessment was available for all the patients. Clinical parameters, neurologic grade, preoperative pain, radiologic evaluation, and outcome measures were analyzed. Survival analysis was performed using the Kaplan-Meier product limit method, and differences between subgroups were analyzed using chi2. Prognostic factors for long-term survival also were evaluated.


RESULTS
The overall median survival after surgery was 30 months, with 18% surviving 5 years or more. Survival varied by tumor type, with the best prognosis noted in patients with breast or kidney cancer. The surgical morbidity was significantly higher in those receiving prior irritation (P < 0.03), and the local recurrence rate also increased in patients who had received prior irradiation.


CONCLUSIONS
Patients with solitary sites of spine involvement from solid tumors represent a biologically favorable subgroup with potential for long-term survival. In this group, complete surgical excision before irradiation should be considered to increase the prospects of long-term palliation and possible cure.
Department of Neurosurgery, 1148 Fifth Avenue, New York, NY 10128, USA. nsundar@mindspring.com.
Narayan
N
Sundaresan
Allen
A
Rothman
Karen
K
Manhart
Kevin
K
Kelliher
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology; D019299:Decompression, Surgical / Q000009:adverse effects / Q000706:statistics & numerical data; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology; D006801:Humans; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010147:Pain Measurement; D010264:Paraplegia / Q000209:etiology; D011379:Prognosis; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D016019:Survival Analysis; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome