title: Surgical management of metastatic disease of the lumbar spine: experience with 139 patients.
abstract: OBJECTIVE
  The surgical treatment of metastatic spinal tumors is an essential component of the comprehensive care of cancer patients. In most large series investigators have focused on the treatment of thoracic lesions because 70% of cases involve this region. The lumbar spine is less frequently involved (20% cases), and it is unclear whether its unique anatomical and biomechanical features affect surgery-related outcomes. The authors present a retrospective study of a large series of patients with lumbar metastatic lesions, assessing neurological and pain outcomes, complications, and survival.
  
  
  METHODS
  The authors retrospectively reviewed data obtained in 139 patients who underwent 166 surgical procedures for lumbar metastatic disease between August 1994 and April 2001. The impact of operative approach on outcomes was also analyzed. Among the wide variety of metastatic lesions, pain was the most common presenting symptom (96%), including local pain, radicular pain, and axial pain due to instability. Patients underwent anterior, posterior, and combined approaches depending on the anatomical distribution of disease. One month after surgery, complete or partial improvement in pain was demonstrated in 94% of the cases. The median survival duration for the entire population was 14.8 months.
  
  
  CONCLUSIONS
  The surgical treatment of metastatic lesions in the lumbar spine improved neurological and ambulatory function, significantly reducing axial spinal pain; results were comparable with those for other spinal regions. Analysis of results obtained in the present study suggests that outcomes are similar when the operative approach mirrors the anatomical distribution of disease. When lumbar vertebrectomy is necessary, however, anterior approaches minimize blood loss and wound-related complications.
authors.affiliation: Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Holman
authors.forename: Dima
authors.initials: D
authors.lastname: Suki
authors.forename: Ian
authors.initials: I
authors.lastname: McCutcheon
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Wolinsky
authors.forename: Laurence D
authors.initials: LD
authors.lastname: Rhines
authors.forename: Ziya L
authors.initials: ZL
authors.lastname: Gokaslan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D010146:Pain; D010147:Pain Measurement; D011183:Postoperative Complications; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000556:secondary* / Q000601:surgery*; D016019:Survival Analysis