Posterior decompression and stabilization for metastatic compression of the thoracic spinal cord: is this procedure still state of the art?

Abstract

Study Design: Retrospective study utilizing the standard patient data documentation of a spinal cord injury (SCI) unit. Objective: To examine the efficacy and outcome of posterior decompression and stabilization for metastatic cord compression. Setting: Orthopedic university hospital with large SCI unit. Methods: The 34 consecutive patients who had presented with symptoms of spinal cord compression due to metastatic disease and progressive neurologic deficit were treated using a uniform surgical approach (posterior decompression and stabilization). After surgery, all treatment options available in a full-featured SCI unit were applied as necessary and suitable. Outcome was rated concerning neurologic function (American Spinal Injury Association, ASIA), functional status (Functional Independence Measure) and pain. The results were compared to the published results, focusing on publications describing results of anterior surgical approaches to the spine. Results: Evaluation of the results of the ASIA exams showed that progression of the neurologic deficit could be stopped in the majority of casesFhowever recovery of neurologic function was rare. The functional status could be improved markedly and good pain reduction was achieved. Conclusion: Immediate surgery can be recommended if the general condition of the patient warrants surgical intervention. Using accepted standards of documentation for SCI, a clear perspective of the results that can be expected is provided. Comparing the results of this study with the current literature there is no evidence that anterior approaches are superior.

Decompression surgery for spinal metastases: a systematic review

“…However, the authors did note that the minimally invasive group had significantly less blood loss (240 ml vs 900 ml, p < 0.01), shorter operation time (2.2 hours vs 3.2 hours, p < 0.01), and shorter bed rest length (2 days vs 4 days, p < 0.01) compared with the open surgery group. Furthermore, the authors also found that patients treated with minimally invasive surgery experienced a greater improvement in quality of life at 30-day follow-up based on the European Organisation for Research and Treatment of Cancer Quality of Life questionnaire (EORTC QLQ-30) (p < 0.01) and EORTC Bone Me- Lung (17) 1 retrospectively studied 34 patients who underwent posterior decompression and stabilization for metastatic compression of the thoracic spinal cord and found that there was no significant difference between the mean ASIA motor score at admission and discharge (72.1 vs 73.5, respectively; p = 0.7). Furthermore, the authors found no evidence that anterior approaches were superior to posterior approaches for MESCC in the thoracic spine.…”

“…Four studies used the American Spinal Injury Association (ASIA) Impairment Scale to assess neurological function. 1,12,23,45 Two studies reported outcomes after decompression without stabilization. Schoeggl et al 39 reported results of decompressive laminectomy with total or partial tumor removal.…”

“…The techniques reported on were posterior decompression and stabilization, posterior decompression without stabilization, and posterior decompression with total or subtotal tumor resection. 1,12,23,39,45 The outcomes measures used to compare surgical technique varied across the 7 included studies. Four studies used the American Spinal Injury Association (ASIA) Impairment Scale to assess neurological function.…”

“…1,12,23,39,45 Three of the studies were retrospective and 2 were prospective. All 5 studies reported primary tumor sites of lung, prostate, and breast, and 4 studies reported primary renal cancers.…”

“…1,3,4,13,[16][17][18][19][20]22,[29][30][31]33,38,39 Fifteen studies were retrospective, and one was a longitudinal observational study. Eleven studies 1,3,4,18,20,22,[29][30][31]33,39 reported outcomes following surgery alone, and 5 studies 13,16,17,19,38 reported the effects of decompression surgery with radiotherapy. Primary tumor sites included lung (15 studies), breast (13 studies), prostate (12 studies), gastrointestinal (8 studies), and renal (4 studies).…”