P07.01 * NEUROSURGICAL TREATMENT OF SPINAL TUMORS IN THE ELDERLY

Abstract

INTRODUCTION: Thanks to the increasing life expectancy and to the improvements made in the treatment of systemic diseases and cancer, combined with advancements in imaging technology, the incidence of spinal tumors has greatly increased in the elderly population. Metastases constitute the majority of lesions, while benign tumors accounts for 25-30% of all spinal neoplasms. The hesitation in performing spinal surgery in aged people is related to the greater likelihood of intra and post-operative complications. Despite this concrete risk, the need for histological diagnosis, root and/or spinal cord decompression, pain relief and improvement of quality of life make surgery quite often a necessary option for this cohort. The primary goal of surgery depends on Histology and tumor extension, but the best surgical result should be faced with the minimal invasiveness, in order to decrease the possible spinal instability and postoperative morbidity and mortality. MATERIALS AND METHODS: We report a series of 70 patients, aged 70 years or more, treated by minimally invasive approach from 2008 to 2013. Forty patients harboured spinal bone metastases, 30 patients benign extramedullary lesions, mainly meningiomas. Surgery was performed to achieve diagnosis and/or decompression of neurological structures; the additional aim for benign lesions was total resection and the further surgical indication for spinal metastases was pain relief. RESULTS: Mono or multisegmental hemilaminectomy in order to preserve the spinal stability was performed in all cases of meningiomas, with gross total removal in 28 patients and subtotal resection in 2 patients. Laminectomy and/or vertebroplasty were performed in the 30% of metastatic cases, followed by internal fixation with screws and rods in the majority of cases in order to reduce back pain primary due to spinal instability. Although this last procedure is not intrinsically minimal invasive, it was performed considering the minimally invasive attitude. Improvement of neurological deficits was achieved in 90% of patients with benign lesions and in the 38 % of spinal metastatic group. In this last group pain relief was also reached in 55% of patients. The rate of mortality, major morbidity and postoperative quality of life was comparable to that of the younger patients. CONCLUSIONS: Until the previous decade, age itself represented quite often a contraindication for surgery, particularly because of the presumed high risk of postoperative morbidity and mortality. Nowadays, planning a tailored anesthetic protocol, surgical strategy and meticulous postoperative assistance, surgical treatment can be offered to this cohort of patients, because their quality of life, referring to neurological deficits and pain, can be greatly improved in the vast majority of cases.