title: Results of posterior surgery with intraoperative radiotherapy for spinal metastases.
abstract: 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.
authors.affiliation: Department of Orthopaedic Surgery, Tokyo Metropolitan Komagome Hospital, 3-18-22 Hon-Komagome, Bunkyo-ku,, Tokyo 113-6877, Japan. tasaitou-tky@umin.ac.jp
authors.forename: Taku
authors.initials: T
authors.lastname: Saito
authors.forename: Taiji
authors.initials: T
authors.lastname: Kondo
authors.forename: Takahiro
authors.initials: T
authors.lastname: Hozumi
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Karasawa
authors.forename: Atsushi
authors.initials: A
authors.lastname: Seichi
authors.forename: Kozo
authors.initials: K
authors.lastname: Nakamura
mesh_terms: 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