SURGICAL TREATMENT OF VERTEBRAL METASTASES

Abstract

Introduction and purpose: The purpose of our study is to make a critical review of our experience and find a method of systematised, objective therapeutic strategy in the treatment of vertebral metastases.

Materials and methods: We reviewed 38 cases of vertebral metastasis (1995–2004) from primary tumours: lung 21%, breast 21%, prostate 12%, renal 12%, ovary 8%, tongue 4%, cavum 4%, melanoma 4%, unknown primary tumour 17%.

24 cases were treated surgically in terms of the clinical criterion agreed between oncologist and traumatologist.

We reviewed the follow-up of the cases (treatment, complications, mortality) and the subsequent application of the Tokuhashi prognostic index and the Tomita therapy protocol with two objectives: to evaluate our results and assess these two methods as working tools.

Results: 74% of the patients had preoperative radiotherapy. The surgical treatment was corporectomy and dorsal decompression (17%), partial corporectomy and dorsal decompression (29%), decompression and dorsal instrumentation (37%) and non-instrumented decompression laminectomy (17%).

The mean survival was 17 months. The surgical treatment controlled pain in 87%; there was neurological improvement in 21%, control in 54% and progression in 25%.

Conclusions: Our results were not as good as those found in the literature, in which the usefulness of postoperative radiotherapy is emphasised.

Preoperative radiotherapy may have made tumour excision more difficult which, together with the delayed decision-making, influenced the loss of efficacy in our cases.

We need more prospective studies to validate the Tokuhashi index and the Tomita protocol, which we think are very useful in taking therapy decisions.