Abstract
Purpose of the study: The goal of palliative surgical treatment of vertebral metastases is to avoid, stabilise, or improve neurological disorders and to relieve pain. We propose early treatment for fixation of threatening lesions and extensive release without resection for programmed surgery outside the emergency context.
Material and methods: From 2001 to 2005, eighty patients underwent scheduled surgery for threatening or symptomatic lesions. Mean age was 59 years (range 32–82). The primary tumour was: breast (n=35), lung (n=19), kidney (n=8), uterus (n=1), prostate (n=2), ENT (n=3), gastrointestinal (n=5), haematology (n=7). Sixty-six patients presented Frankel B to D neurological involvement. The Tokuhashi score was 8 on average (range 5–9) and the Karnofsky index 57% (range 30–70). Sixty-four patients had visceral metastases. On average 7 levels were instrumented (range 4 to 8). The procedure included laminectomy in all cases.
Results: Blood loss was 500 cc (300–2700) and operative time 110″ (65–110). Fifty-nine patients recovered one or more Frankel grade. Six patients (7%) developed a postoperative infection. The actuarial survival at one year was 78%; 95% for patients free of motor neurological involvement and 65% for the others. This difference was significant.
Discussion: Spinal metastases should be detected and treated before emergency care is required. At the present time this treatment is well programmed. Fixation without tumour resection enables prolonged survival and allows time for other treatments in a pluridisciplinary management scheme. Several therapeutic options are possible but converge towards improved quality of life.
Conclusion: Posterior tumour resection is not useful for palliative surgical management of vertebral metastases. We propose an active approach using a simple well-defined surgical procedure without waiting for development of a neurological emergency.
Correspondence should be addressed to Ghislaine Patte at sofcot@sofcot.fr
