Results of posterior surgery with intraoperative radiotherapy for spinal metastases.
OBJECTIVE
Spinal cord compression from spinal metastasis represents a substantial clinical problem. Complete resection of spinal metastases is difficult in many cases, and conventional surgical decompression of the spinal cord with or without instrumentation often results in unsatisfactory neurological recovery and local recurrence, even if combined with external radiotherapy. To increase rates of local control and improve neurological recovery in such cases, we introduced decompressive surgery combined with intraoperative radiotherapy (IORT) for the treatment of spinal metastasis in 1992. We report the results of neurological recovery and local control in cases that received surgery with IORT.


METHODS
Between November 1992 and December 2001, 133 cases (117 patients) were treated using IORT at Tokyo Metropolitan Komagome Hospital. The 79 cases (74 patients) that received posterior spine surgery only for spinal paresis due to spinal metastasis were reviewed.


RESULTS
Improvement of at least one level according to Frankel's classification was attained in 68 cases (86%). Of the 58 patients unable to walk preoperatively, 45 patients (78%) regained walking ability postoperatively. Rate of local recurrence was 2.5%.


CONCLUSIONS
IORT, combined with posterior surgery and FERT, might be one of the effective methods for local control of spinal metastasis and neurological improvement, especially in cases with progressive and multi-level lesions.
Saito
Taku
T
Department of Orthopaedic Surgery, Tokyo Metropolitan Komagome Hospital, 3-18-22 Hon-Komagome, Bunkyo-ku,, Tokyo 113-6877, Japan. tasaitou-tky@umin.ac.jp
Kondo
Taiji
T
Hozumi
Takahiro
T
Karasawa
Katsuyuki
K
Seichi
Atsushi
A
Nakamura
Kozo
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D010291:Paresis / Q000532:radiotherapy / Q000601:surgery*; D011878:Radiotherapy / Q000379:methods*; D013117:Spinal Cord Compression / Q000532:radiotherapy / Q000601:surgery*; D013125:Spinal Neoplasms / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery; D016896:Treatment Outcome