Surgery in spinal metastasis without spinal cord compression: indications and strategy related to the risk of recurrence

Surgery in patients presenting with vertebral metastasis without neural def icit is controversial. A series of 107 patients (54 female, 53 male) were o perated on at a mean age of 58. The metastasis was the first manifestation of the cancer in seven cases. In 100 patients, the cancer had been diagnose d 30 months earlier (average). Vertebral pain was present in all cases, wit h associated radicular pain in 43 cases. Pyramidal irritation without neura l deficit was present in seven cases. The mean preoperative Karnofsky index was 64.7%. The mean preoperative Tokuhashi score was 8.6. The surgical app roach depended on the topography of the metastasis. Ninety-three patients w ere dead at review, with a mean survival of 8 months. Seventeen patients un derwent further spinal surgery, for local recurrence in nine cases, and for another spinal localization in eight cases, after a mean interval of 8 mon ths. Recurrence occurred at the same level in all seven patients presenting with neural deficit at recurrence. Among ten recurrences without neural de ficit, two were observed at the same level and eight were observed on anoth er level. Surgery in vertebral metastasis without neural deficit results in substantial functional improvement, but does not increase the duration of life. For kidney metastasis, total vertebrectomy must be performed because of the risk of recurrence. For thyroid metastasis, total vertebrectomy is a good alternative to increase the efficacy of iodotherapy. In other cases, for patients with good general status, surgery must be adapted to the locat ion of the involvement.