UNILATERAL POSTEROLATERAL DECOMPRESSION WITHOUT STABILIZATION FOR NEUROLOGICAL PALLIATION OF SYMPTOMATIC SPINAL METASTASIS IN DEBILITATED PATIENTS

Patients with symptomatic spinal metastases and limited life expectanc y are often too debilitated to withstand anterior or posterolateral sp inal cord decompression and segmental stabilization. More limited surg ery aiming solely at preservation or restoration of neurological funct ion and relief from pain offers the potential for significant improvem ent in the quality of remaining life without incurring undue periopera tive morbidity and mortality. Eight patients with spinal metastases an d Limited life expectancy underwent a unilateral transpedicular decomp ression procedure on their most symptomatic side and/or the side of ma ximum tumor involvement. All patients were neurologically improved wit hin the 1st postoperative week; all were ambulatory and continent post operatively. Postoperatively, all five patients with preoperative moto r deficits demonstrated increased motor strength, and the three patien ts with predominant radicular pain reported marked improvement. There were no perioperative deaths and two transient perioperative complicat ions. The average length of hospitalization was 6 days for patients wi thout complications and 10 days for the entire group. Unilateral trans pedicular decompression without stabilization is an effective and safe method for palliating symptomatic spinal metastases in debilitated pa tients with widespread malignancy and limited life expectancy. This th erapeutic option should be considered in select cases as an alternativ e to either nonoperative management or anterior or posterolateral deco mpression and segmental stabilization.