MICROSURGERY OF THE CERVICAL-SPINE IN ELDERLY PATIENTS .2. SURGERY OFMALIGNANT TUMOROUS DISEASE

In this retrospective study, the results of surgery were examined in 2 5 patients, 65 years of age or older, suffering from malignant tumour growth along the cervical spine. The group consisted of 17 men and 8 w omen. The mean age was 73 years, ranging from 66 to 88 years. The path ology identified was metastasis in 23 patients, and plasmocytoma in tw o. The tumour localization involved a single segment of the cervical s pine in 12 patients, two segments in 8 patients, three segments in 4 p atients, and four segments in one patient. Pre-operatively, 8 patients (32%) suffered solely from severe pain. 6 patients (24%) showed sever e pain and radicular nerve compression. 5 patients (20%) had incomplet e para- or tetraparesis but were able to walk, and again 6 patients (2 4%) had incomplete para- or tetraparesis, and were unable to walk. A m ultitude of accompanying systemic diseases was present in the majority of patients. Evaluation of the peri-operative risk profile was perfor med using the American Society of Anaesthesiology (ASA) Grading of Phy sical Status Score. Operation consisted of microsurgical tumour remova l, usually incorporating a single- or multi-level vertebrectomy, with radical epidural decompression, and grafting with bone cement followed by an appropriate osteosynthesis. Of the whole cohort of patients tre ated, four patients were still alive at the time of the last follow-up evaluation. 21 patients died. Four patients died within seven days af ter surgery. The remaining 17 patients died during the follow-up perio d. All of these patients died from systemic spread of their primary ca ncer. The results of surgery in terms of postoperative neurological ou tcome were as follows: 11 patients or 44% were improved by surgery. 7 patients (28%) were unchanged, three patients (12%) became worse, and four patients (16%) died. With regard to functional outcome, 73% of th e patients with severe pre-operative neurological deficits showed sign ificant postoperative amelioration of symptoms. 19 patients became amb ulatory until the final stage of their disease. It is concluded, that according to the results of this limited study, a general nihilistic o r purely conservative approach for the treatment of elderly patients s uffering from secondary malignancy of the cervical spine is not justif ied. With proper patient selection, aggressive surgery leads to signif icant amelioration of pre-operatively existing neurological deficits a nd long-term ambulation in a considerable percentage of the patients.