Outcomes of palliative surgery in metastatic disease of the cervical and cervicothoracic spine

Abstract

This prospective study was undertaken to assess the clinical outcome of 26 consecutive patients who underwent surgery for symptomatic metastases of the cervical or cervicothoracic spine. All patients suffered axial or radicular pain, with or without neurological deficit, including radicular weakness (23%), quadriplegia or paraplegia (12%), and urinary sphincter dysfunction (8%). All patients underwent palliative decompression and stabilization surgery via an anterior (18 patients), posterior (7 patients) or combined approach (1 patient) depending on the topography of the metastases, and were prospectively followed up for 1 year. Thirteen patients received adjuvant chemotherapy and 7 patients received radiotherapy to the cervical lesion. Clinical data as well as data from the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire were obtained pre- and postoperatively and at regular follow-up intervals. Median survival was 6 months and 10 patients were known survivors at 12 months. Postoperatively, 1 patient developed neurological deterioration and died while an inpatient. There were no other early postoperative complications in any patients. From pre- to postoperatively there was an immediate and significant improvement in axial and radicular pain and overall quality of life. There was also overall improvement in cognitive, emotional, social, role, and physical functioning. The observed improvement in pain, functioning, and quality of life was maintained for the duration of the follow-up period. Furthermore, neurological function was improved or preserved until death in the majority of patients. Together with adjuvant medical management, surgery for cervical metastases produces low morbidity and can achieve good symptomatic palliation in the majority of patients for their remaining lifetime.