[Neurological outcome of 152 surgical patients with spinal metastasis]

Abstract

Background and purpose: The aim of this study is to evaluate retrospectively the benefit of the surgical spinal decompression in 152 patients with spinal metastasis.

Methods: Based on clinical notes and GP inquiry, we determined the actuarial survival curve, and assessed the pain level one month post-operatively and the motor, the sensory and sphincter distrurbances three months after surgery.

Results: Thoraco-lumbar lesions were usually treated using a posterior approach, with a laminectomy and if necessary an osteosynthesis. Cervical lesions were treated with an anterior approach, i.e. a corporectomy and a methylmetacrylate stabilization. Sixty eight percent of patients (103/152) had pre or postoperative radiotherapy. After the surgical decompression for a spinal metastasis, our study demonstrated an improvement in sensory status (31 % of the patients), in motor ability (56 %), in sphincter function (51 %), and a decrease in the pain intensity in 47 % of the patients. Among 83 patients who could not walk on admission (grade A, B and C of Frankel), 52 % recovered a gait function 3 months post operatively. The best benefit after surgery concerned grade C patients, of which 71 % recovered the gait function. Two percent of the patients had postoperative worsening of their motor strength. No operative mortality was noted, and the postoperative mortality rate was 3 % at 7 days and 9 % at 30 days. The analysis of the actuarial survival curve demonstrated a mean follow up of 3.7 years. The mean survival time was 12 months with 25 % of patients surviving 2 years.

Conclusion: Surgical decompression is effective in relieving neurological symptoms from spinal metastasis. In our experience a complete motor deficit does not seem to be a good surgical indication because of the lack of postoperative improvement.