The neurosurgical management of spinal metastases causing cord and cauda equina compression

Abstract

The authors report a series of 100 consecutive patients with spinal metastases causing cord or cauda equine compression, who were treated with surgical decompression. Of these, 30% (all women) had breast cancer. The most common primary neoplasm in man was prostatic carcinoma. Pain was the earliest and most prominant symptom, followed by weakness. Bladder dysfunction was recorded in 40 patients. The thoracic region was the most common site of cord compression (76 patients). Surgical treatment involved urgent and extensive laminectomy decompression. Concomitant spinal stabilization was required in 10 cases, involving posterior rib graft fusion in seven and Harrington rod instrumentation in three. At last follow-up review, 29 of these patients were living with an average postoperative survival of 2.3 years; 71 patients had died with an average survival of 8.8 months. Surgical decompression produced effective pain relief in 70% of the patients. Postoperatively, 58 patients could walk; of these, 40 were walking and continent of urine 6 months following surgery (including five patients who were totally paraplegic on admission). Positive approach and aggressive management in this problem can achieve results superior to those generally reflected in the literature.

Epidural metastatic spinal cord compression: functional outcome and survival after inpatient rehabilitation

“…7,10 The mean survival of patients with neoplastic spinal cord compression (SCC) after developing neurological signs is between 3 and 9 months. [11][12][13][14] Although it has been estimated that over 80% of patients with neoplastic SCC survive no longer than 1 year, a select group of patients may survive for extended periods, sometimes as long as 4-9 years. [12][13][14][15] Epidural metastatic SCC has a major influence on the patient's physical condition.…”

“…[11][12][13][14] Although it has been estimated that over 80% of patients with neoplastic SCC survive no longer than 1 year, a select group of patients may survive for extended periods, sometimes as long as 4-9 years. [12][13][14][15] Epidural metastatic SCC has a major influence on the patient's physical condition. Patients are confronted with significant impairment in mobility, self-care, bowel and bladder management and sexuality.…”

Paraplegia due to spinal epidural neoplasia

“…meningioma). Malignancy seems highly probable if local, often irradiating, pain is followed by usually rapid progressive signs of involvement of the spinal cord or cauda equina, if X-ray films reveal osteoplastic or osteolytic lesions of the pedicle or vertebral body, bone scanning shows a 'hot spot' and myelography is positive (Hall & Mackay, 1973;Livingston & Perrin, 1978). Evidence of a primary tumour or of multiplicity of lesions provides further support (Cobb et at., 1977).…”

“…There was and there still is disagreement whether radiotherapy alone is as (in-)effective as decompressive laminectomy followed by irradiation. The view of some authors is that the effect of radiotherapy is too slow, they prefer decompressive laminectomy in most cases (Livingston & Perrin, 1978). Khan et al (1967), Brady et al (1975) and Gilbert et al (1978) consider surgical therapy unnecessary in most cases, in particular when Dexamethasone is also administered.…”

“…These therapies, which are essentially palliative, are not given if treatment seems to be of no avail to the natural course, for example if the patient has only a limited amount of pain, has already a com plete paraplegia or a severe incomplete paraplegia which developed within 48 hours. In these cases recovery is extremely rare (Hall & Mackay, 1973;Livingston & Perrin, 1978). Haematological disorders form an important exception to this rule.…”