title: Palliative considerations in the surgical treatment of spinal metastases: evaluation of posterolateral decompression combined with posterior instrumentation.
abstract: OBJECTIVE
  To evaluate the outcome of patients with spinal metastases, treated under palliative considerations by spinal decompression and sole posterior instrumentation, in respect to survival, neurological symptomatology, pain, ECOG grade, and Tomita's prognostic score (TPS).
  
  
  METHODS
  Fifty-seven consecutive patients with metastatic vertebral tumors were treated using a posterolateral approach for decompression combined with posterior instrumentation. Mean age was 58.6 years. In average, 3.4 vertebral segments were involved in instrumentation.
  
  
  RESULTS
  Preoperative mean TPS was 5.9. The majority of the patients (70.2%) presented with an ECOG grade ≤2. The distribution of the metastatic lesions that needed surgical treatment was: 7.8% cervical, 60.9% thoracical, and 31.3% lumbar. In 52.6% the tumor led to pathological vertebral fractures. Mean pain VAS scores improved significantly in all but one patient from 6.6 preoperatively to 3.1 postoperatively. Post-surgical Frankel grades decreased. Mean postoperative survival was 11.4 months. Ten patients survived until now. Forty-seven patients have died with a mean survival of 9 months. Complication rate was only 5.3% with two superficial wound infections and one seroma. Not a single case of posterior spinal instrumentation fatigue failure was detected.
  
  
  CONCLUSIONS
  Palliative surgical treatment for metastatic spinal tumors using a decompressive posterolateral approach combined with sole posterior instrumentation achieved convincing clinical results. All patients with intractable pain showed significant improvement postoperatively, and neurological deterioration was avoided. Since patients with spinal metastases enter the terminal stage of their disease, it is generally agreed that they require only palliative surgical treatments. Accordingly, spinal decompression and stabilization may be performed to improve the quality of the remaining life of cancer patients.
authors: Department of Neurosurgery, Jena University Hospital, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany. jan.walter@med.uni-jena.de
authors: Jan
authors: J
authors: Walter
authors: Rupert
authors: R
authors: Reichart
authors: Albrecht
authors: A
authors: Waschke
authors: Rolf
authors: R
authors: Kalff
authors: Christian
authors: C
authors: Ewald
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059186:Chemoradiotherapy, Adjuvant / Q000379:methods; D019299:Decompression, Surgical / Q000379:methods; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010148:Intractable Pain / Q000601:surgery; D011183:Postoperative Complications; D011379:Prognosis; D018714:Radiotherapy, Adjuvant / Q000379:methods; D013117:Spinal Cord Compression / Q000209:etiology / Q000532:radiotherapy / Q000601:surgery*; D013125:Spinal Neoplasms / Q000150:complications / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult