IntroductionThe principal drawback of surgery for bony metastatic locations, particularly vertebral metastases (VM), is, for many surgeons, the relative frequency of complications due to the procedures themselves. We decided to verify whether this fear is well founded by determining the frequency of immediate and secondary complications of such surgery, and to look for causes or predisposing factors that might point to means for reducing the frequency of these complications. Materials and methodsWe carried out a retrospective study of 145 patients operated in our unit between 1982 and 1991 for vertebral metastasis of malignant tumours. The surgery was indicated to reduce pain, prevent onset or aggravation of neural deficits, and to improve the quality of life of the patients. Primary vertebral tumours were excluded from this series. Vertebral locations of haematological malignancies, which involve problems similar to those encountered in solid tumour metastases, were, on the other hand, included. EpidemiologyPrimary tumor (Table 1) The 145 patients operated were among 155 patients hospitalized between 1982 and 1991 in our unit, for secondary locations of malignant tumours. Among these 155 patients, the primary tumour had already been diagnosed in 103 patients at the time that one or more metastases were detected. Vertebral metastasis was the inaugural manifestation of cancer in the other 52 patients (33.5%).In the majority of cases in which the primary tumour was already known at diagnosis of vertebral metastasis, either breast cancer (n = 39, 37.8%), lung cancer (n = 13, 12.6%) or colon cancer (n = 8, 7.7%, all colic locations combined) was involved.Among the rarer locations were noted tumours of the kidney, prostate, uterus (neck or body), oesophagus and bladder. We classed the even rarer tumours into the category "others" (synoviosarcoma, neuroendocrine carcinoma, leiomyosarcoma, malignant melanoma, malignant fibrous histiocytoma, tumour of the pancreas, tumour of the pharynx), when they were already diagnosed at the time of discovery of VM. AbstractThe authors report their experience concerning complications of spinal metastasis surgery. The purpose of this study was to assess the frequency of such complications and analyse the factors influencing their occurrence. The records of 145 patients treated between 1982 and 1991 for metastatic disease of the spine were retrospectively reviewed for intra-and postoperative complications. Other factors such as radiation therapy, emergent nature of surgery, and neurologic deficits were analysed for potential correlations with the frequency of complications. Twentyseven (18.6%) patients developed postoperative complications. Wound dehiscence and infection (11%) were the most frequent complications. Statistical analysis showed a significant influence of three factors: preoperative radiation therapy, paraplegia before surgery, and surgery under emergency conditions. The rate of complications in this surgery is lower than might be expected and can be significantly reduced....

This study evaluated the effects of propofol on somatosensory evoked cortical potentials in 20 ASA grade 1 or 2 patients who underwent spinal surgery. Anaesthesia consisted of propofol, dextromoramide, 50% nitrous oxide and oxygen mixture. The induction dose of propofol was 2 mg/kg and was followed by an infusion of 6 mg/kg for the first hour and 3 mg/kg subsequently. Somatosensory evoked cortical potentials were recorded on the scalp and compared to pre-operative values using Student's paired t-test. We observed a significant depression of evoked potential 10 minutes after induction, which continued until the early phase of recovery. Because of its short and quickly reversible action, propofol is an acceptable agent when clinical monitoring of the spinal cord is indicated but is not satisfactory when monitoring has to be based on somatosensory cortical evoked potentials.

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