Neurological outcome following laminectomy in spinal metastases

Abstract

Study design: Retrospective outcome measurement study. Objectives: Patients suering from malignant tumour disease and metastases to the spine develop a variety of clinical complaints including radicular symptoms and/or spinal cord compression syndromes. Palliative decompressive laminectomy with total or partial tumour resection is an acknowledged method of treatment, despite controversy. Setting: The Department of Neurosurgery of the University of Vienna. Method: Patients suering from metastases with predominant in®ltration of the dorsal epidural parts, or patients who could not be operated on via an anterior approach, were included. Eighty-four patients who met these criteria underwent decompressive laminectomy with total or partial tumour removal. The study analyzed motor function, pain relief and continence in a 2-and 4-month post-operative follow-up. According to the criteria of motor performance, 20% of the patients had been mobile pre-operatively. Results: In the immediate post-operative period 45%, after 2 months 33% and after 4 months 26%, were considered mobile. None of the paraplegic patients showed functional improvement. The median survival time was 6.5 months. Pre-operatively, 56% of the patients had shown continence dysfunction. Post-operatively, 38%, and after 2 months 46% of the patients, developed continence disorders. A signi®cant reduction in analgesic medication was also observed in the post-operative period. Conclusion: In our series, palliative laminectomy with total or subtotal tumour reduction in patients with malignant spinal metastatic disease resulted in amelioration of motor function, pain and continence and therefore improved the patients' quality of life. The improvement in quality of life shows that this method is a valuable option in neurosurgical therapy, except for cases with pre-operative paraplegia. However, in patients with severe pre-operative paraparesis, the authors recommend laminectomy only in very exceptional cases, because of the poor post-operative neurological results.

Decompression surgery for spinal metastases: a systematic review

“…1,12,23,45 Two studies reported outcomes after decompression without stabilization. Schoeggl et al 39 reported results of decompressive laminectomy with total or partial tumor removal. The authors found that patients undergoing this technique experienced an improvement in their quality of life based on a reduction in analgesic consumption postoperatively and a decrease in the total percentage of patients experiencing continence disorders following surgery (Table 3).…”

“…The techniques reported on were posterior decompression and stabilization, posterior decompression without stabilization, and posterior decompression with total or subtotal tumor resection. 1,12,23,39,45 The outcomes measures used to compare surgical technique varied across the 7 included studies. Four studies used the American Spinal Injury Association (ASIA) Impairment Scale to assess neurological function.…”

“…1,12,23,39,45 Three of the studies were retrospective and 2 were prospective. All 5 studies reported primary tumor sites of lung, prostate, and breast, and 4 studies reported primary renal cancers.…”

“…1,3,4,13,[16][17][18][19][20]22,[29][30][31]33,38,39 Fifteen studies were retrospective, and one was a longitudinal observational study. Eleven studies 1,3,4,18,20,22,[29][30][31]33,39 reported outcomes following surgery alone, and 5 studies 13,16,17,19,38 reported the effects of decompression surgery with radiotherapy. Primary tumor sites included lung (15 studies), breast (13 studies), prostate (12 studies), gastrointestinal (8 studies), and renal (4 studies).…”

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“…Despite the evidence, however, this procedure continues to be performed by some surgeons. 74 The results of decompressive laminectomy seem to be improved if internal fixation (for example, pedicle screws) and fusion are performed as well. In a review of 134 patients treated with either a laminectomy (111 patients) or laminectomy with stabilization (23 patients), Sherman and Waddell, 75 found that the latter group had better posttreatment ambulatory status (92 compared with 57%), sphincter function, and pain control, and less recurrent neurological dysfunction.…”