Role of surgery in the treatment of spinal cord compression by metastatic neoplasm

White, William A.; Patterson, Russel H.; Bergland, Richard M.

doi:10.1002/1097-0142(197103)27:3<558::aid-cncr2820270307>3.0.co;2-e

Cited by 84 publications

(22 citation statements)

References 6 publications

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“…1 Decompressive laminectomy had to be performed on 20 of our patients due to neurological deterioration after having received radiotherapy. Interestingly, these patients showed ± even though to only a small degree ± a better prognosis compared to those receiving 1,6,10,11,18,20 Nevertheless, the disadvantage of the dorsal approach lies in the inability to remove completely a ventrally located tumour 3,7,14,15,17,19,21 rendering relatively moderate results even following subtotal tumour extirpation. 4,7 We found ventral or ventrolateral as well as cued spinal cord compression in 85% of our patients.…”

Section: Discussionmentioning

confidence: 99%

Neurological outcome following laminectomy in spinal metastases

2002

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Study design: Retrospective outcome measurement study. Objectives: Patients suering from malignant tumour disease and metastases to the spine develop a variety of clinical complaints including radicular symptoms and/or spinal cord compression syndromes. Palliative decompressive laminectomy with total or partial tumour resection is an acknowledged method of treatment, despite controversy. Setting: The Department of Neurosurgery of the University of Vienna. Method: Patients suering from metastases with predominant in®ltration of the dorsal epidural parts, or patients who could not be operated on via an anterior approach, were included. Eighty-four patients who met these criteria underwent decompressive laminectomy with total or partial tumour removal. The study analyzed motor function, pain relief and continence in a 2-and 4-month post-operative follow-up. According to the criteria of motor performance, 20% of the patients had been mobile pre-operatively. Results: In the immediate post-operative period 45%, after 2 months 33% and after 4 months 26%, were considered mobile. None of the paraplegic patients showed functional improvement. The median survival time was 6.5 months. Pre-operatively, 56% of the patients had shown continence dysfunction. Post-operatively, 38%, and after 2 months 46% of the patients, developed continence disorders. A signi®cant reduction in analgesic medication was also observed in the post-operative period. Conclusion: In our series, palliative laminectomy with total or subtotal tumour reduction in patients with malignant spinal metastatic disease resulted in amelioration of motor function, pain and continence and therefore improved the patients' quality of life. The improvement in quality of life shows that this method is a valuable option in neurosurgical therapy, except for cases with pre-operative paraplegia. However, in patients with severe pre-operative paraparesis, the authors recommend laminectomy only in very exceptional cases, because of the poor post-operative neurological results.

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Section: Discussionmentioning

confidence: 99%

Neurological outcome following laminectomy in spinal metastases

2002

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“…57 There is a growing body of evidence in the literature to support anterior decompression for anterior compressive lesions. 19,22,27,30,37,38,45,47,52,61,67,70 The use of thoracotomy has produced good functional results, but related morbidity such as persistent pleural effusions, hemothorax, chylothorax, and dural-pleural fistulas has been reported. 20,55,56 In addition, the 30-day mortality rate in patients undergoing thoracotomy for metastasis has been reported to range from 3 to 30 %.…”

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confidence: 99%

Perioperative complications with costotransversectomy and anterior approaches to thoracic and thoracolumbar tumors

Wiggins¹,

Mirza²,

Bellabarba³

et al. 2001

FOC

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Object Anterior decompression and stabilization for thoracic spinal tumors often involves a thoracotomy and can be associated with surgical approach–related complications. An alternative to thoracotomy is surgery via a costotransversectomy exposure. To delineate the risks of surgery, the authors reviewed their prospective database for patients who had undergone surgery via either of these approaches for thoracic or thoracolumbar tumors. The complications were recorded and graded based on severity and risk of impact on patient outcome. Methods Between September 1995 and April 2001, the authors performed 29 costotransversectomies (Group 1) and 18 thoracolumbar or combined (Group 2) approaches as initial operations for thoracic neoplasms. The age, sex, pre-operative motor score, and preoperative Frankel grade did not significantly differ between the groups. In the costotransversectomy group there were greater numbers of metastases, upper thoracic procedures, and affected vertebral levels; additionally, the comorbidity rate based on Charlson score, was higher. The mean Frankel grades at discharge were not significantly different whereas the discharge motor and last follow-up motor scores were better in Group 2. There were 11 Group 1 and seven Group 2 patients who suffered at least one complication. The number or patients with complications, the mean number of complications, and severity of complications did not differ between the groups. Conclusions Compared with anterior or combined approaches, the incidence and severity of perioperative complications in the surgical treatment of thoracic and thoracolumbar spinal tumors is similar in patients who undergo costotransversectomy. Costotransversectomy may be the preferred operation in patients with significant medical comorbidity or tumors involving more than one thoracic vertebra.

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“…No other factors were identified which predicted survival following cord compression including number of metastatic sites. (Constans et al, 1983;White et al, 1971;Findlay, 1984 , 1989). If in addition, there is a history of back pain, the risk of SCC rises.…”

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confidence: 99%

Spinal cord compression in breast cancer: a review of 70 cases

Richards²,

Gregory³

et al. 1993

Br J Cancer

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Summary Spinal cord compression (SCC) is a relatively uncommon but frequently disabling complication of metastatic breast cancer. We have conducted this retrospective study of 70 patients with SCC secondary to breast cancer with the aims of determining risk factors for its development and predictors of outcome. Median age at diagnosis of breast cancer was 51 years with median time to SCC 42 months. All patients had radiological evidence of bone metastases at the time of SCC, and only five were not known to have bone metastases prior to SCC. The most frequent symptom of SCC was motor weakness (96%) followed by pain (94%), sensory disturbance (79%) and sphincter disturbance (61 %). Ninety-one percent of patients had at least one symptom for more than a week.Radiotherapy ( Details of radiotherapy treatment given to the spine before the onset of neurological deficit were also obtained from the case notes as were the numbers of patients who developed cord compression during radiotherapy being given for pain control. Treatment for cord compression varied according to individual circumstances. In general, surgical decompression was preferred if the patient was otherwise fit, if the signs were rapidly progressive and if the site had previously been irradiated, whereas radiotherapy was given to patients with more slowly progressive symptoms or signs at previously non-irradiated site (Coleman & Rubens, 1987 Table I, and these are also shown for the denominator population of all patients seen in the unit over this

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Role of surgery in the treatment of spinal cord compression by metastatic neoplasm

Cited by 84 publications

References 6 publications

Neurological outcome following laminectomy in spinal metastases

Neurological outcome following laminectomy in spinal metastases

Perioperative complications with costotransversectomy and anterior approaches to thoracic and thoracolumbar tumors

Spinal cord compression in breast cancer: a review of 70 cases

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