Surgical treatment of metastatic vertebral tumors.
Surgical treatment of metastatic spinal cord compression is controversial. The purpose of this study was to investigate the effectiveness of our current surgical treatments and the use of spinal instrumentation. In this retrospective study covering the years between 1990 and 2006, 100 patients with spinal metastases which were secondary to various cancers underwent posterior and/or anterior decompression with spinal stabilization for the purposes of reduction of pain, and/or to help correct or improve neurological deficits. The group was made up of 60 men and 40 women whose ages ranged from 16 to 83 years (average of 60 years), and the average follow-up period was 14 months. The effect of treatment upon pain relief and neural deficits was assessed, and the cumulative survival rate was calculated by the Kaplan-Meier method. The average surgical time was 185 min. This was calculated based on the following times, listed here with the surgery type: 178 min for posterior surgery; 245 min for anterior surgery;465 min for combined surgery;and 475 min for total en bloc spondylectomy. Average blood loss during surgery was 1,630 ml for posterior surgery, 1,760 ml for anterior surgery, 1,930 ml for combined surgery, and 3,640 ml for total en bloc spondylectomy. Preoperative pain and paralysis were improved by 88% and 53%, respectively. In regards to surgical complications, postoperative epidural hematoma was observed in 2 patients, and instrumentation-related infection was observed in 1. Only 2 patients died within 2 months of surgery. In conclusion, posterior and/or anterior decompression with spinal stabilization is a safe and effective treatment for patients with spinal metastases, and can improve their quality of life.
Tanaka
Masato
M
Department of Orthopaedic Surgery, Okayama University Hospital, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. tanakam@md.okayama-u.ac.jp
Nakahara
Shinnosuke
S
Ito
Yasuo
Y
Kunisada
Toshiyuki
T
Misawa
Haruo
H
Koshimune
Koichiro
K
Ozaki
Toshifumi
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000601:surgery; D011183:Postoperative Complications; D011788:Quality of Life; D012189:Retrospective Studies; D013123:Spinal Fusion; D013125:Spinal Neoplasms / Q000556:secondary / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult