Skeletal metastases are an increasing sequaelae for patients with a wide range of neoplastic lesions owing to the increasing incidences of cancer. The diagnosis of a skeletal metastasis is, however, at present a terminal diagnosis representing uncontrolled tumour dissemination. The metastatic destruction of the bone reduces its load bearing capabilities progressing to the principle orthopaedic complication, that of complete loss of cortical integrity.
This is a retrospective study of all patients within the Cardiff centre who underwent an operation for a metastatic bone lesion over a 10 year period (n=140). The patients were identified using pathological records created when samples were sent at the time of the operations. The patients were all followed up for a minimum of 24 months. The demographics of the patients were collected and a detailed analysis of the primary tumour, the surgical procedure, the mobility, and survival of the patients was undertaken. The patients data was then cross referenced with the database at the regional cancer centre and the post operative radiotherapy treatment regimen were collected. Patients who underwent prophylactic surgical stabilization had a significant survival advantage compared to those stabilized following a fracture (p=0.002). The morbidity postoperatively, defined by the patients functional mobility, also shows the benefits of prophylactic stabilization with significantly improved mobility when compared to the mobility following fracture stabilization (p=0.033). It has also been shown that there is a significant postoperative survival benefit for those patients who were able to regain mobility (p<
0.01). Our results show a significant survival benefit of prophylactic fixation rather than fixation following fracture which is in line with previous studies We have also, for the first time in a large number study, shown that there is a survival benefit for patients who are able to mobilize following surgery and if prophylactic stabilization was undertaken patients were significantly more mobile postoperatively.
Lumbar spinal surgery may be associated with considerable pain in the early postoperative period. This often leads to a delay in patient mobilisation and a consequent increase in the risk of developing perioperative complications. Several studies have demonstrated the efficacy of intrathecal opioids for analgesia following spinal surgery. We present our experience of using intrathecal diamorphine for analgesia following lumbar spinal surgery. Data were collected on all patients undergoing surgery who received intrathecal diamorphine and stored on a database (Microsoft Access).