title: [Surgical treatment and prognosis factors in spinal metastases of breast cancer].
abstract: OBJECTIVE
  The aim of this study was the evaluation of surgical therapy results and prognosis factors in patients with spinal metastases of breast cancer.
  
  
  METHODS
  55 patients with spinal metastases of breast cancer who were treated surgically were retrospectively evaluated. In 11 patients the cervical, in 27 patients the thoracic and in 17 patients the lumbar spine was affected.
  
  
  RESULTS
  Postoperatively, 45 patients (81.8 %) described a reduction in pain and 5 patients (50 %) reported a neurological improvement. Perioperative complications appeared in 27 patients (49.1 %), 2 patients died. For the entire group, the mean postoperative survival was 27.2 +/- 28.6 months and the median survival 16.2 months. In patients with solitary metastasis the univariate analysis did not show a significantly longer postoperative survival than in patients with additional visceral metastases (p = 0.0659), but patients with solitary metastasis showed a significantly longer survival than those with multiple osseous and/or visceral metastases (p = 0.0325). In the univariate analysis, the classification of the primary tumour, the duration of symptoms, the localisation of the metastases, the patient's age and the kind of surgical procedure (posterior stabilising instrumentation versus combined posterior-anterior treatment with intralesional resection of the affected vertebra and vertebral body replacement) did not show a significant influence on the postoperative survival. The multivariate analysis did not show a significant prognostic influence for the potentially prognostic factors, however, solitary and multiple metastasis showed the highest statistical influence for the prognosis (p = 0.1187), followed by the classification of the primary tumour (p = 0.1243).
  
  
  CONCLUSIONS
  Pain reduction and neurological improvement can be reached by a stabilisation of the diseased spinal region. Patients with spinal metastases due to breast cancer showed a relatively long postoperative median and mean survival. Therefore, the preoperative evaluation of extent of the disease and the therapy concept should be individually adapted. The surgical procedure (posterior stabilising instrumentation versus combined posterior-anterior approach with vertebrectomy and vertebral body replacement) does not significantly influence the survival.
authors.affiliation: Orthopädische Klinik mit Querschnittgelähmtenzentrum der Universität Ulm im Rehabilitationskrankenhaus Ulm. benjamin.ulmar@medizin.uni-ulm.de
authors.forename: B
authors.initials: B
authors.lastname: Ulmar
authors.forename: M
authors.initials: M
authors.lastname: Richter
authors.forename: B
authors.initials: B
authors.lastname: Cakir
authors.forename: A
authors.initials: A
authors.lastname: Brunner
authors.forename: W
authors.initials: W
authors.lastname: Puhl
authors.forename: K
authors.initials: K
authors.lastname: Huch
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001416:Back Pain / Q000401:mortality* / Q000601:surgery*; D001943:Breast Neoplasms / Q000401:mortality*; D002277:Carcinoma / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D015984:Causality; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007796:Laminectomy / Q000706:statistics & numerical data; D008875:Middle Aged; D009017:Morbidity; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D013123:Spinal Fusion / Q000706:statistics & numerical data; D013125:Spinal Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome