Fifty-one consecutive patients with metastatic lesions of the cervical spine were treated surgically. The most common primary tumor types were breast cancer and myeloma. In 14 (27%) patients, the cervical lesion was the first manifestation of the malignancy. All patients suffered from severe pain but only six had long tract symptoms. Five tetraparetic patients were confined to bed. Vertebral body collapse occurred in 73% of cases. The surgical technique was individualized according to the patient's general condition, the site of metastasis on the vertebra, and the level and number of levels bearing in mind that the treatment is palliative in nature. The goal of treatment was a better quality of life. In the upper cervical spine the technique described by Sjöström et al. was used, if technically possible. If the odontoid process had been totally destroyed, an occipitocervical stabilization was chosen. In the lower cervical spine, an anterior approach was used to resect the tumor growth. Anterior support was provided with bone cement if the patient was not expected to survive long; otherwise bone grafting was used. In cases with two or more levels of involvement, a combined anteroposterior stabilization was usually performed. Good pain relief was achieved postoperatively. The operation was generally well-tolerated by the patients, mild dysphagia being the most common complaint. One patient died 2 days postoperatively of heart failure, giving a postoperative mortality of 2%. Rhizopathy symptoms were relieved totally in 15 patients and partially in 6.(ABSTRACT TRUNCATED AT 250 WORDS)

The efficacy of 'limited posterior surgery' for metastases in the thoracic and lumbar spine was studied prospectively in 51 patients (32 men and 19 women, mean age 64 years). The most common primary tumors were prostate, breast, and renal carcinoma, 37 patients had metastases in the thoracic spine and 14 in the lumbar spine. Indications for surgery were severe pain or neurologic deficit. Of the 46 patients with neurologic symptoms, 25 were unable to walk. Surgery was confined to direct or indirect decompression and stabilization with a pedicle screw fixator over few segments as possible. Pain, as well as a variety of functional performance parameters and residential status were registered preoperatively and after surgery at 3, 6, 9, and 12 months, and at 6-monthly intervals thereafter. Pain was rated by the patient on a Visual Analog Scale, and functional performance was assessed with the Eastern Co-operative Oncology Group (ECOG) Performance Status Scale. We had no perioperative neurologic deterioration or death. Nineteen of the 25 nonambulatory patients regained their walking ability. Postoperative pain relief was significant and lasting over time. Nearly half of the patients attained improvement in functional performance. The median survival was 8 months. Older age and intact postoperative walking ability were positive factors for survival.

Spinal metastases are common in malignant disease. For selected patients with severe pain or neurological dysfunction, surgical treatment offers valuable palliation. During the last few years, we have treated between 100 and 120 patients annually with spinal metastases at the Department of Orthopedics, Uppsala University Hospital, Uppsala, Sweden. A detailed preoperative analysis is mandatory for optimal patient selection. Preoperative embolization of spinal metastases of renal cell carcinoma minimizes the peroperative blood loss. Most cervical spinal metastases are best treated via an anterior approach with vertebral body resection and primary reconstruction of the anterior column. Most thoracic or lumbar spinal metastases are best treated via a posterior approach with decompression and stabilization, using a transpedicular fixation device. However, patients with an expected survival exceeding 6-12 months, a secondary reconstruction of the anterior column should be considered.

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