Surgical management of symptomatic spinal metastases - Postoperative outcome and quality of life

Study Design. Eighty-six surgical interventions in 76 consecutive patients with symptomatic spinal metastases were reviewed retrospectively. Objectives. To evaluate the postoperative outcome and quality of life of pa tients surgically treated for symptomatic spinal metastases. Summary of Background Data. The standard surgical treatment for patients wi th symptomatic spinal metastases is anterior spinal cord decompression with stabilization. However, because therapy is only palliative, satisfactory q uality of life and high patient acceptance are essential. Methods. The medical records of all patients were reviewed retrospectively, Furthermore, all surviving patients or the next of kin of deceased patient s were interviewed by telephone, and the family doctors or the care-providi ng physicians of external institutions were contacted. Results. First-choice surgical treatment was anterior spinal cord decompres sion with stabilization. Postoperative mean survival was 13.1 months, and m ean time at home after spinal surgery was 11.1 months. Neurologic improveme nt with regard to Frankel classification was observed in 58% of the patient s, and 93% were able to walk postoperatively. Pain relief was noted in 89%. Overall, 67% of the patients achieved moderate or good general health as s hown by the Karnofsky Index, and 80% were satisfied or very satisfied with the surgical intervention. Moreover, 19% of the surgical interventions were associated with complications, local tumor recurrence developed in 22% of the patients, and paraplegia ultimately developed in 18% of patients. Conclusions. Surgical management of symptomatic spinal metastases, in parti cular anterior decompression, is of benefit in most metastatic lesions in t erms of satisfactory postoperative outcome and quality of life. However, in patients with melanoma or lung carcinoma, the authors advocate spinal surg ery only in very exceptional cases.