Abstract
OBJECTIVE: To evaluate the impact of surgical treatment of metastatic epidural spinal lesions on the quality of life of patients, pain relief and survival. METHODS: Patients with single or double spinal lesions, in good clinical conditions to undergo surgery, were included. Staging and prognostic evaluation were performed, based on imaging studies, according to the criteria of Enneking and Tokuhashi, and neurological status (Frankel), pain (visual analogue scale, VAS) and quality of life index (Oswestry) were also assessed. Survival was calculated. RESULTS: The study included 67 patients, 34 men and 33 women, aged 13-88 years (mean: 53). Most had the breast (23 cases) as the primary site of the tumor and metastasis in the lumbar region, especially in L2 and L3. Pathologic fractures were diagnosed in 45 patients. The mean VAS score was initially 9 (5-10) reducing in the second day after surgery to 2 (1-7) and to 1 (0-6) in the first and sixth months. Following 6 months, 18 deaths were observed (one intraoperatively, five in the first month and 12 at 6 months). The neurological status was correlated with survival: patients who were Frankel E before surgery showed increased survival. CONCLUSION: The surgery does not influence patient survival, except for patients with neurological deficits, who have a worse prognosis. Treatment of metastatic lesions is often palliative, but patients present improved neurological and pain relief and few complications after surgery, justifying surgical intervention.
Highlights
An estimated 1.47 million cases of cancer are diagnosed annually in the United States.[1]
The objective of this study is to evaluate the results of the surgical treatment of epidural metastatic lesions of the spine, evaluating the impact of surgery on the patients’ quality of life, pain relief, and correlating with primary focus, sex, and survival
The region that was primarily affected by cancer was the breast in 23 cases, the prostate in 11 cases, the gastrointestinal system in seven cases, the lung in six cases, the kidney in five cases, the thyroid in three cases, the uterus in three cases, and the tumor was hematopoietic in four cases
Summary
An estimated 1.47 million cases of cancer are diagnosed annually in the United States.[1]. The metastatic involvement of the spine can be manifested in various ways, and pain is the main symptom, present in virtually all cases, often intensively, and leads the patient to a decrease of their activities, and, in many cases, to a restriction of ambulation.[8] The presence of bony destruction very often leads to fracture, instability, and deformity. It progresses to the more severe presentation, which is neural compression, either by a pathologic fracture or tumoral invasion.[9,10]
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