Abstract
Introduction
Metastatic involvement of the lumbo-sacral junction/sacrum usually signifies advanced disease. The aim of this study was to report our results on the management of patients with metastases referred to this anatomical region over the last 5 years (July 2006- July 2010).
Methods
Retrospective analysis from a comprehensive spinal oncology database.
Results
During this period, a total of 14 patients (mean age 65.6 years (58-87), 8 female, 6 male) were referred to our unit. The majority had symptoms of pain and neurological deterioration (11) with onset of pain considerably longer than neurology symptoms (296 days (7-1825) versus 7 days (1-28); 3 were non-ambulatory at presentation. The primary tumours were Renal cell (4), Breast (2), Prostate (2), GI (2), unknown primary (2), lung (1) and neuroendocrine (1).
Operative procedures performed were decompression with lumbo-pelvic stabilisation (5), decompression with(out) biopsy (7), posterior decompression/reconstruction with anterior excision/stabilisation (1) and laminectomy with sacroplasty (1). There were 8/14 (57%) complications including neurological deterioration (2), wound infection (2) and metalwork revision (1). Post-operatively, 7 patients received radiotherapy, 3 improved one Frankel grade and the others remained stable. All patients were ambulatory. The mean survival was 412 days (105-1005) and most patients returned either back to their own home (8) or a nursing home (4).
Conclusion
The incidence of metastases in this region is relatively uncommon. Surgical intervention has a high complication rate (8/14, 57%) but can be important in restoring/preserving neurological function, assisting with ambulatory function and allowing patients to return to their previous accommodation.
