title: Improvement in pain after lumbar surgery in cancer patients with mechanical radiculopathy.
abstract: BACKGROUND
  Lumbar metastases can result in spinal instability and mechanical radiculopathy, characterized by radicular pain produced by axial loading. This pain pattern represents a definitive symptom of neoplastic instability and may serve as a reliable indication for surgical stabilization.
  
  
  OBJECTIVE
  We examined the results of surgical decompression and fixation in the treatment of mechanical radiculopathy.
  
  
  METHODS
  A retrospective clinical study.
  
  
  METHODS
  An internally maintained spine neurosurgery database was queried between February 2002 and April 2010. Patients were identified and deemed eligible for inclusion in this study based on the presence of all the following: metastatic tumor, lumbar surgery, and lumbar radiculopathy.
  
  
  METHODS
  Visual analog scale (VAS) of pain and Eastern Cooperative Oncology Group (ECOG) status.
  
  
  METHODS
  The Memorial Sloan-Kettering Cancer Center Department of Neurosurgery operative database was queried over an 8-year period to identify all patients with spinal metastases who underwent lumbar surgery. Only patients whose operative indication included mechanical radiculopathy were included. Pre- and postoperative pain was assessed with the VAS of pain, whereas pre- and postoperative performance status was evaluated using the ECOG.
  
  
  RESULTS
  Fifty-five patients were included in the cohort. L2 and L3 were the most common levels involved, and most patients underwent multilevel posterior decompression and instrumented fusion. After surgery, 98% of patients reported pain relief. A significant difference between average pre- and postoperative pain scores was found (p<.01). Overall, 41.5% of patients experienced improvement in their ECOG score postoperatively.
  
  
  CONCLUSIONS
  Mechanical radiculopathy in patients with spinal metastases represents a highly reliable surgical indication. Spinal decompression and fixation is an effective treatment for pain palliation in this patient population.
authors.affiliation: Department of Neurosurgery, Yale School of Medicine, South Frontage Road and Park Street, New Haven, CT 06510, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Moliterno
authors.affiliation: Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
authors.forename: Clinton A
authors.initials: CA
authors.lastname: Veselis
authors.affiliation: Department of Anesthesiology, Columbia University, 622 West 168th Street, New York, NY 10032, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Hershey
authors.affiliation: Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Lis
authors.affiliation: Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
authors.forename: Ilya
authors.initials: I
authors.lastname: Laufer
authors.affiliation: Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA. Electronic address: bilskym@mskcc.org.
authors.forename: Mark H
authors.initials: MH
authors.lastname: Bilsky
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D005592:Fracture Fixation / Q000379:methods; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010146:Pain / Q000601:surgery*; D010147:Pain Measurement; D011184:Postoperative Period; D011843:Radiculopathy / Q000209:etiology* / Q000601:surgery*; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000150:complications*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Fracture; Instability; Mechanical pain; Radiculopathy; Spine metastases; Tumor