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Surgical management of vertebral neoplasia: Who, when, how and why?

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Summary

To determine the role of surgery in vertebral neoplasia, we conducted a retrospective review of patients undergoing surgery for vertebral neoplasia in the Royal Orthopaedic Hospital, Birmingham, and Coventry and Warwickshire Hospital, Coventry. Surgery included decompression, stabilisation or both. The neurological status was assessed by Frankel grading before and after surgery. Of 70 patients undergoing surgery, 14 were neurologically intact preoperatively, and a further 25 were weak but ambulatory. Following surgery, 35 were intact, and a further 22 were ambulatory. Sixty-six patients (94%) obtained good pain relief. Survival correlated with histology and younger age at presentation, but not with level, neurology at presentation or type of surgery. We conclude that neurological status, pain relief and mechanical stability are better after appropriate surgery than after radiotherapy or inappropriate surgery. Failure to consider the surgical option may deny the chance of significant neurological recovery.

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References

  1. Black P (1979) Spinal metastasis: current status and recommended guidelines for management. Neurosurgery 5: 726–746

    PubMed  Google Scholar 

  2. Boccardo M, Ruelle A, Mariotti E, Severi P (1985) Spinal carcinomatous metastases. Retrospective study of 67 surgically treated cases. J Neurooncol 3 251–257

    PubMed  Google Scholar 

  3. Brice J, McKissock W (1965) Surgical treatment of malignant extradural spinal tumours. Br Med J 1: 1341–1344

    Google Scholar 

  4. Denis F (1983) The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine 8: 817–831

    PubMed  Google Scholar 

  5. Fenn LG, Savaraj N (1990) Detection of occult bone metastasis by MRI scan. J Fla Med Assoc 77: 881–883

    PubMed  Google Scholar 

  6. Findlay GFG (1984) Adverse effects of the management of malignant spinal cord compression. J Neurol Neurosurg Psychiatry 47: 761–768

    PubMed  Google Scholar 

  7. Findlay GFG (1987) The role of vertebral body collapse in the management of malignant spinal cord compression. J Neurol Neurosurg Psychiatry 50: 151–154

    PubMed  Google Scholar 

  8. Findlay GFG (1989) Management of spinal secondary tumours. Br J Hosp Med 42: 386–393

    PubMed  Google Scholar 

  9. Frankel HL, Hancock DO, Hyslop G, Melzak J, Michaelis LS, Ungar GH, Vernon JDS, Walsh JJ (1969) The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia (part 1). Paraplegia 7: 179–192

    PubMed  Google Scholar 

  10. Galasko CSB (1991) Spinal instability secondary to metastatic cancer. J Bone Joint Surg [Br] 73: 104–108

    Google Scholar 

  11. Gilbert R, Kim JH, Posner J (1978) Epidural spinal cord compression from metastatic tumour: diagnosis and treatment. Ann Neurol 3: 40–51

    PubMed  Google Scholar 

  12. Harrington KD (1986) Metastatic disease of the spine. J Bone Joint Surg [Am] 68: 1110–1115

    Google Scholar 

  13. Harrington KD (1988) Anterior cord decompression and stabilisation of the spine as a treatment for vertebral collapse and spinal cord compression from metastatic malignancy. Clin Orthop 233: 177–197

    PubMed  Google Scholar 

  14. Harrison KM, Muss HB, Ball MR, McWhorter M, Case D (1985) Spinal cord compression in breast cancer. Cancer 55: 2839–2844

    PubMed  Google Scholar 

  15. Johnston FG, Uttley D, Marsh HT (1989) Synchronous vertebral decompression and posterior stabilisation in the treatment of spinal malignancy. Neurosurgery 25: 872–876

    PubMed  Google Scholar 

  16. King GJ, Kostiuk JP, McBroom RJ, Richardson W (1991) Surgical management of metastatic renal carcinoma of the spine. Spine 16: 265–271

    PubMed  Google Scholar 

  17. Magerl F, Jeanneret B (1988) Surgical management of tumour related spinal instability. Recent Results Cancer Res 108: 163–171

    PubMed  Google Scholar 

  18. Manabe S, Tateishi A, Mitsutoshi A, Ohno T (1989) Surgical treatment of metastatic tumours of the spine. Spine 14: 41–47

    PubMed  Google Scholar 

  19. Marsh H (1990) Metastatic disease of the spine. Br J Neurosurg 4: 167–170

    PubMed  Google Scholar 

  20. Nather A, Bose K (1982) The results of decompression of cord or cauda equina compression from metastatic extradural tumours. Clin Orthop 169: 103–108

    PubMed  Google Scholar 

  21. Nottebaert I, Hochstetter AR von, Exner GU, Schreiber A (1987) Metastatic carcinoma of the spine. Int Orthop 11: 345–348

    PubMed  Google Scholar 

  22. O'Neil J, Gardner V, Armstrong G (1986) Treatment of tumours of the thoracic and lumbar spinal column, Clin Orthop 227: 103–112

    Google Scholar 

  23. Onimus M, Schraub S, Bertin D, Bosset JF, Guidet M (1986) Surgical treatment of vertebral metastasis. Spine 11: 883–891

    PubMed  Google Scholar 

  24. Perrin RG, McBroom RJ (1987) Anterior versus posterior decompression for symptomatic spinal metastasis. Can J Neurol Sci 14: 75–80

    PubMed  Google Scholar 

  25. Schaberg J, Gainor BJ (1985) A profile of metastatic carcinoma of the spine. Spine 10: 19–20

    PubMed  Google Scholar 

  26. Seddon HJ (1935) Pott's paraplegia: prognosis and treatment. Br J Surg 22: 769–799

    Google Scholar 

  27. Shibasaki K, Harper CG, Bedbrook GM, Kakalus BA (1983) Vertebral metastases and spinal cord compression. Paraplegia 21: 47–61

    PubMed  Google Scholar 

  28. Siegal T, Siegal T (1985) Surgical decompression of anterior and posterior malignant epidural tumours compressing the spinal cord: a prospective study. Neurosurgery 17: 423–432

    Google Scholar 

  29. Siegal T, Siegal T (1989) Current considerations in the management of neoplastic cord compression. Spine 14: 223–228

    PubMed  Google Scholar 

  30. Solini A, Paschero B, Orsini G, Guercio N (1985) The surgical treatment of metastatic tumours of the lumbar spine. Ital J Orthop Traumatol 11: 427–442

    PubMed  Google Scholar 

  31. Stark RJ, Henson RA, Evans SJW (1982) Spinal metastases. A retrospective review from a general hospital. Brain 105: 189–213

    PubMed  Google Scholar 

  32. Sundaresan N, Galicich JH, Lane JM, Bains MS, McCormack P (1985) Treatment of neoplastic epidural cord compression by vertebral body resection and stabilisation. J Neurosurg 63: 676–684

    PubMed  Google Scholar 

  33. Tokuhasi Y, Matsuzaki H, Toriyama S, Kawano H, Ohsaka S (1990) Scoring system for the preoperative evaluation of metastatic spine tumour prognosis. Spine 15: 1110–1113

    PubMed  Google Scholar 

  34. Watson P, Spiro SG, Barrett-Lee P, Hansell DH, Dennison DM, Fuller RW, Collins JV (1991) Managing spinal cord compression in small cell lung cancer. Br Med J 302: 103–105

    Google Scholar 

  35. Wong DA, Fornasier VL, MacNab I (1990) Spinal metastases: the obvious, the occult and the impostors. Spine 15: 1–4

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Royal Orthopaedic Hospital, B31 2AP, Birmingham, UK

    S. J. Krikler, D. S. Marks & A. G. Thompson

  2. Coventry and Warwickshire Hospital, Coventry, UK

    W. F. Merriam

  3. Queen Elizabeth Hospital, Birmingham, UK

    D. Spooner

Authors
  1. S. J. Krikler
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  2. D. S. Marks
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  3. A. G. Thompson
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  4. W. F. Merriam
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  5. D. Spooner
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Krikler, S.J., Marks, D.S., Thompson, A.G. et al. Surgical management of vertebral neoplasia: Who, when, how and why?. Eur Spine J 3, 342–346 (1994). https://doi.org/10.1007/BF02200148

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