Surgical Decompression of Anterior and Posterior Malignant Epidural Tumors Compressing the Spinal Cord: A Prospective Study

Abstract

Of 167 episodes of spinal epidural neoplastic compression, 86 were treated by operation. The surgical approach was prospectively selected according to the location of the tumor in the spinal canal. Decompression was achieved by 61 vertebral body resections (VBRs) and by 25 laminectomies. The indications for operation were: neurological relapse after previous radiotherapy, the need to make a tissue diagnosis, a radioresistant tumor, and neurological deterioration during radiotherapy. Before VBR, 28% (17 of 61) were still able to walk, 51% (31 of 61) were parAparetic, and 21% (13 of 61) were paraplegic. Bowel and bladder dysfunction was present in 49% (30 of 61). After VBR, the outcome of only 57 procedures was available for evaluation because of the postoperative death of 4 patients. Eighty per cent (46 of 57) were able to walk, 18% (10 of 57) were paraparetic, and 2% (1 of 57) were paraplegic. Ninety-three per cent had normal sphincter control. Before laminectomy, 8% (2 of 25) were ambulatory, 84% (21 of 25) were paraparetic, and 8% (2 of 25) were paraplegic. Bowel and bladder dysfunction was present in 76% (19 of 25). After laminectomy, only 23 procedures were evaluated because of the postoperative death of 2 patients. Thirty-nine per cent (9 of 23) were ambulatory, 35% (8 of 23) were paraparetic, and 26% (6 of 23) were paraplegic. Fifty-seven per cent regained normal sphincter control. The operative mortality was 7% (4 of 61) in VBR and 8% (2 of 25) in laminectomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Positive and negative prognostic variables for patients undergoing spine surgery for metastatic breast disease

“…This is in contrast to reports in the literature, that suggest, that breast metastases confined to the skeletal system have a better overall prognosis [6,8,34,43,45]. In our series, which includes patients with and without visceral metastases, the overall median survival from time of surgery was 21 months, which is comparable to some reported series [52] and longer than others [39,46,47,49,53]. Furthermore, the extent of metastatic disease was not associated with the risk of major postoperative complications.…”

Metastatic spinal cord tumours

“…It is not quite effective in anteriorly located tumours and may cause increased spinal instability. Recent reports advise anterior cord de compression plus spinal fusion with acrylic and metal instruments especially in anterior located tumours Harrington, 1984;Siegal, 1985;Overby, 1985). We had only 2 cases who had an anterior decompression and anterior bony fusion.…”

“…In cases during or after radiotherapy when neurological deteriora tion occurs surgery must be performed (Siegal, 1985). This occurred in 13% of the patients.…”

“…Metastatic cord tumours are pathologies which localise mainly in the thoracic regions (Constans, 1983) and cause neurological deterioration due to vertebral body collapse (Harrington, 1984;Siegal, 1985).…”

“…Decompressive laminectomy has two main disadvantages Siegal, 1985). It is not quite effective in anteriorly located tumours and may cause increased spinal instability.…”