Surgery for Symptomatic Spinal Metastases – When, What, and How?

Abstract

Abstract Background: Spine is the most common site for metastases in the skeletal system. Longer lifespans of patients with common cancers are translating into increasing incidence of patients with symptomatic spinal metastases. Surgery for spinal metastases offers immediate neurological decompression with stabilization and preservation of quality-of-life parameters. Objectives: To assess the effect of pre operative neurological condition, timing, and type of surgery on post operative neurological function and long-term outcome. To analyze the various sources of primary in cases of symptomatic spinal metastases and the spinal level involved in terms of post operative neurological function and ambulation. Material and Methods: A retrospective analysis of all operated cases of symptomatic spinal metastases at our institute over a period of 5 years was performed. Parameters such as neurological presentation, timing of surgery, source of primary, radiological features of the metastases were assessed and compared with the type of surgery performed, post operative neurological function and long-term outcome. The in house hospital information system was to collect data. Results: A total of ninety-four patients were operated for symptomatic spinal metastases, the dorsal spine was the most common location and haematological malignancies were the most common primary overall and among men whereas breast was the most common primary in females. Overall, 64.8% of the patients had neurological motor deficit of which 72% had an improvement in motor power. We found that patients with a pre operative motor power of 3/5 or more likely to have in improvement in post operative neurological function and ambulatory status. Conclusion: Surgery for symptomatic spinal metastases plays a vital role in preserving the quality of life of the patients. Patients with preoperative motor power of 3/5, spastic tone and features of mechanical back pain alone have good ambulatory outcomes post spine surgery.