[Metastatic tumors in vertebral canal]

Medical records of patients suffering from spinal cord or cauda equina compression secondary to metastatic tumour of the spinal canal were reviewed. Out of 55 patients treated in the Department of Neurosurgery in Lublin throughout 1976-1996 for metastatic disease of the spinal canal, forty were operated on. Clinical symptoms, methods of treatment and course of disease in this last group of patients were analysed. It showed that the great majority of patients are admitted to the neurosurgical department with severe neurological deficits. Eighty percent of patients (n = 40) presented with deterioration of gait and 67.5% had retention of urine, 72.5% had sphincter disturbances. The series comprised patients with carcinoma of the lung (22.5%), kidney (7.5%), prostate (7.5%), neoplastic disease of the lymphatic system (12.5%) and other malignant neoplasm accounting for 62.5%. As a general rule, decompressive laminectomy was carried out. Surgery was usually performed as an emergency in order to arrest progression of neurological deficits and to prevent irreversible damage to the roots and spinal cord. The tumours were usually extradural, located in the lower part of the thoracic spine and invading surrounding tissues, including bone. Histological diagnosis of spinal tumour as a metastasis preceded diagnosis of a primary tumour, but in 1/3 of cases histology could not indicate of the primary malignancy. There are substantial differences in the clinical course of a metastasis in the thoracic and lumbosacral spine. Own experience indicates that surgery of spinal metastases in patients with severe neurological deficits has a very limited effectiveness.