STABILIZING OPERATIONS ON THE SPINE IN EX TRADURAL METASTATIC DISEASE- INDICATIONS AND EPICRISIS FROM 32 PATIENTS

Over 4.5 years, 32 patients with spinal epidural metastases were decom pressed and stabilized. Median survival was 9.5 months. Myelopathy was the predominant indication (41%) for the operation, intractable pain (microinstability) the second most important. The type of tu mor sprea ding a nd biomechanics necessitated ventral decompression and stabiliz ation in 65%. Corporectomy or extensive laminectomy was always combine d with internal fixation and bone cement. With the exception of six pa tients (5 early deaths), all patients were able to walk after surgery. The Karnofsky index was improved significantly from 35 to 66%. The lo ngest survival time was found in breast carcinomas and myelomas. Preop erative radiological embolization was a keystone in the treatment. Ind ication for surgery in spinal metastases is critical and needs an inte rdisciplinary approach. When the patient is suffering from higher degr ees of paresis or even paralysis, he/she is no longer an ideal candida te for the operation. The same applies in the presence of uncontrolled primary tumors and neoplastic disease of the GI tract and the bronchu s.