Results of surgical treatment of spinal thoracic and lumbar metastases.

Abstract

The results of surgical treatment of vertebral metastases were evaluated from a retrospective review of a consecutive series of 100 patients, with special reference to anatomoclinical aspects and functional outcome. The primary tumour in most cases was lung, breast, or prostate; it was unknown in 11 cases. Diagnosis of the metastasis occurred 4-86 months after that of the primary tumour (lung metastasis: 4 months; breast metastasis: 86 months; prostatic metastasis: 22 months). Patients complained of vertebral pain in 96 cases and/or radicular pain in 43 cases. Intractable pain was observed in lung metastasis in particular. All patients received analgesics, and 57 received morphinics. Walking was impossible for 50 patients. Thirty-eight patients presented with neurologic deficit; neurologic status varied according to the primary tumour. Treatment included anterior surgery in 58 patients, posterior surgery in 33 patients, and combined surgery in 9 patients. Mean duration of hospitalisation was 12 days. No patient was admitted to the intensive care unit. Mean follow-up was 13.5 months. Eighty-nine patients were dead at follow-up, with an average survival of 10 months. Mean survival time was 7 months for patients with lung metastasis, 12 months for those with breast metastasis and 24 months for those with prostatic metastasis. Ten patients were still alive at follow-up (mean follow-up period 45 months, range 17-72 months). Analgesics were stopped for 62 patients following discharge from hospital. Morphinics had to be continued in seven patients. Thirty-five patients out of 50 (70%) recovered walking capacity. Neurologic status improved in 30 out of 38 patients. Although duration of survival was limited, surgery proved to be beneficial in providing a significant and early improvement in the functional status of more than 80% of patients. A precise evaluation of preoperative pain is necessary. Pain is dependent upon the bony lesion, the primary tumour, and the tumoral topography, which defines the surgical approach.