Abstract
PurposeWhile radiotherapy is generally an acceptable treatment for metastatic spinal cord compression, surgical intervention is controversial due to the invasiveness and diversity of diseases in the patients being considered. The ideal treatment, therefore, depends on the situation, and the most acute treatment possible is necessary in patients presenting with myelopathy. We compared the neurological outcomes between radiotherapy and surgery in patients with metastatic spinal cord compression presenting with myelopathy.MethodsA total 54 patients with metastatic spinal cord compression presenting with myelopathy treated in our institution between 2006 and 2016 were analyzed retrospectively. Twenty patients were selected by radiotherapy alone (radiation group), and 36 patients were selected by decompression and stabilization surgery with or without radiotherapy (surgery group). The neurological outcomes and complications were compared between the two treatment groups.ResultsSeven patients initially in the radiation group underwent surgery because of a substantial decline in their motor strength during radiotherapy. One of the remaining 13 patients (8%) in the radiation group and 30 of the 34 patients (88%) in the surgery group showed improvement in their neurological symptoms (P < 0.01). One patient (8%) in the radiation group and 21 patients (62%) in the surgery group were ambulatory after treatment (P < 0.01). There were no major complications related to radiotherapy, but surgery-related complications occurred in 9 of 34 (26%) patients, and 6 (18%) patients needed reoperation.ConclusionsSurgical decompression and stabilization may be required to improve the neurological function in patients with metastatic spinal cord compression presenting with myelopathy. However, the high rate of complications associated with surgery should be taken into consideration.
Highlights
Metastatic spinal cord compression (MSCC) has been reported to occur in 5–14% of cancer patients [1, 2]
Twenty patients were selected by radiotherapy alone, and 34 patients were selected by surgery with or without radiotherapy
The location of spinal metastasis was in the cervical spine in 1 patient and in the thoracic spine in 19 patients in the radiation group and in the cervical spine in 1 patient and in the thoracic spine in 33 in the surgery group
Summary
Metastatic spinal cord compression (MSCC) has been reported to occur in 5–14% of cancer patients [1, 2]. The term “MSCC” includes several conditions, and many reports have failed to standardize the major neurologic factors to compare the outcome between radiotherapy and surgery. Patients presenting with myelopathy need acute treatment for neurological recovery, as paralysis can proceed rapidly otherwise. The symptom and the compression level of the spinal cord are important factors to consider when deciding on surgical treatment. Suggest that the symptoms (myelopathy or radiculopathy) and the compression level of the spinal cord (cervethoratic or lumbar) should be clearly noted when discussing treatment concerning the neurological outcome of patients with MSCC. We report the neurological outcomes following treatment by radiotherapy alone or surgery in patients who presented with myelopathy with spinal cord compression in the cervethoratic region
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