Neurological outcome of 152 surgical patients with spinal metastasis

Background and purpose. - The aim of this study is to evaluate retrospectiv ely the benefit of the surgical spinal decompression in 152 patients with s pinal metastasis. Methods. - Based on clinical notes and GP inquiry, we determined the actuar ial survival curve, and assessed the pain level one month post-operatively and the motor, the sensor, and sphincter disturbances three months after su rgery. Results. - Thoraco-lumbar lesions were usually treated using a posterior ap proach, with a laminectomy and if necessary an osteosynthesis. Cervical les ions were treated with an anterior approach, i.e. a corporectomy and a meth ylmetacrylate stabilization. Sixty eight percent of patients (103/152) had pre or postoperative radiotherapy. After the surgical decompression for a s pinal metastasis, our study demonstrated an improvement in sensory status ( 31 % of the patients), in motor ability (56 %), in sphincter function (51 % ), and a decrease in the pain intensity in 47 % of the patients. Among 83 p atients who could not walk on admission (gr nde A, B and C of Frankel), 52 % recovered a gait function 3 months post operatively. The best benefit aft er surgery concerned grade C patients, of which 71 % recovered the gait fun ction. Two percent of the patients had postoperative worsening of their mot or strength. No operative mortality was noted, and the postoperative mortal ity rate was 3 % at 7 days and 9 % at 30 days. The analysis of the actuaria l survival curve demonstrated a mean follow up of 3.7 years. The mean survi val time was 12 months with 25 % of patients surviving 2 years. Conclusion. - Surgical decompression is effective in relieving neurological symptoms from spinal metastasis. In our experience a complete motor defici t does not seem to be a good surgical indication because of the lack of pos toperative improvement.