The surgical treatment of metastatic disease of the spine

Abstract

Background and purpose: The spine is the commonest site for skeletal metastases. The majority of patients with spinal metastases can be managed conservatively, at least initially, but a significant number will develop complications, either neurological or mechanical, requiring surgical intervention. This paper emphasizes the need for a spinal surgeon to be involved early in the care of these patients. Materials and methods: Forty-two patients undergoing surgery for metastatic disease of the spine between January 1995 and June 1997 were reviewed. Thirty-five of the patients had ‘instability’ pain secondary to pathological vertebral fracture, 25 of whom also had radicular pain secondary to nerve root compression. Six patients had radicular pain but no symptoms of instability. Two of these patients had symptoms of spinal claudication and one further patient had symptoms of spinal claudication alone. Forty of the patients had evidence of thecal compression on magnetic resonance imaging scans and 29 had neurological signs. According to the grading of Frankel (Paraplegia 7 (1969) 179), 14 had a major neurological deficit and 15 had a minor neurological deficit. All patients underwent decompression of the cord or nerve roots and spinal stabilization, 25 via a posterior approach, 15 via an anterior approach and two combined. Results: Post-operatively pain improved in 38 of the 42 patients (90%), the neurological deficit in 20 of the 29 patients with a deficit (69%) and the ambulatory ability in 25 of the 32 patients (78%) with very restricted mobility. Conclusions: Identification of the cause of a patient's symptoms allows appropriate surgical intervention with favourable results.