OPERATIVE THERAPY FOR SKELETAL METASTASES

Bone metastases of the vertebral spine occur frequently after breast c ancer, hypernephroma or thyroid carcinoma. Located commonly in the lum bar and thoracic spine, half of the lesions are found in the vertebral body, but in many cases lamina and pedicles are also involved. Pain r esistant to conservative treatment, vertebral compression fracture and segmental instability, together with progredient neurologic deficits and para- or tetraplegia, all make operative intervention mandatory. I n this article dorsal decompression and stabilization are compared to ventral decompression and compound osteosynthesis. Segmental stability and life-time prognosis of the patient are important factors to decid e on the best surgical procedure. Dorsal decompression without stabili zation should only be performed as a palliative procedure in patients with an inoperative tumor, poor prognosis, or if the estimated postope rative segmental stability seems to be sufficient. In cases of a solit ary metastasis, after radical resection of the primary tumor and when the prognosis is good total vertebrectomy can be performed. In additio n to surgical treatment, adjuvant chemotherapy and/or radiation therap y should be performed in a multidisciplinary setting.