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Palliative considerations in the surgical treatment of spinal metastases

Evaluation of posterolateral decompression combined with posterior instrumentation

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Abstract

Purpose

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).

Patients and 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.

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Abbreviations

CT:

Computerized tomography

CUP:

Cancer of unknown primary origin

ECOG:

Eastern cooperative oncology group

KPS:

Karnowsky performance scale

MRI:

Magnetic resonance imaging

NHL:

Non Hodgkin lymphoma

PDL:

Posterior decompressive laminectomy

RT:

Radiation therapy

TES:

Total en-bloc spondylectomy

TPS:

Tomita’s prognostic score

VAS:

Visual analog scale

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Acknowledgments

We would like to acknowledge the support and contribution of A. Depta, Dr. H. Schmalenberg, M.D., and co-workers from the Tumor Center of the Friedrich-Schiller-University, Jena.

Conflict of interest

The authors have no conflicts of interest to declare.

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Authors and Affiliations

  1. Department of Neurosurgery, Jena University Hospital, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany

    Jan Walter, Rupert Reichart, Albrecht Waschke, Rolf Kalff & Christian Ewald

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  1. Jan Walter
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  2. Rupert Reichart
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  3. Albrecht Waschke
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  4. Rolf Kalff
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  5. Christian Ewald
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Correspondence to Jan Walter.

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Walter, J., Reichart, R., Waschke, A. et al. Palliative considerations in the surgical treatment of spinal metastases. J Cancer Res Clin Oncol 138, 301–310 (2012). https://doi.org/10.1007/s00432-011-1100-3

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