Abstract
To review indications, complications and outcome for revision surgery in metastatic spinal disease.
Retrospective review of casenotes and radiographs.
13 patients (9 male, 4 female) identified from a cohort of 222 patients who underwent surgery for spinal tumours between 1994- 2001.
Indication for revision, complications, survival. Further recurrence (same or different level). Further surgery, neurological grade and pain score.
Of 13 patients (4 Renal, 6 breast, 2 prostate, 1 myeloma) one is alive 101 months following revision. Two have been lost to follow up, 10 have died (mean survival 25.3 months post op). The mean time between primary and revision surgery was 10 months (range 1- 32 months)
4 disease progression (same level), 4 new level disease, 3 loss of fixation, 1 radiological collapse, 1 progressive kyphus. Approaches used: 4 anterior, 8 posterior, 1 posterior + anterior. The mean number of levels which required instrumentation on revision was 5.
Modal pain score pre op 5, modal post op 3, minimum one point improvement. Preop modal Frankel grade E, postoperatively all preserved or improved one grade. Modal Karnofsky score preop 70 (30- 90), postop 80 (40-90)- all but one at least 10 point increase. Complications: 1Dural tear, 1 bacteraemia, 1 chylothorax, 1 loss of fixation. 3 patients required further surgery (range 4 months- 18 months, mean 11 months)
Patients with metastatic disease may benefit from second procedures for recurrent disease whether locally or distant with excellent survival, low complications and good function.
