[Neurological outcome of 152 surgical patients with spinal metastasis]

The aim of this study is to evaluate retrospectively the benefit of the surgical spinal decompression in 152 patients with spinal metastasis.

Based on clinical notes and GP inquiry, we determined the actuarial survival curve, and assessed the pain level one month post-operatively and the motor, the sensory and sphincter distrurbances three months after surgery.

Thoraco-lumbar lesions were usually treated using a posterior approach, with a laminectomy and if necessary an osteosynthesis. Cervical lesions were treated with an anterior approach, i.e. a corporectomy and a methylmetacrylate stabilization. Sixty eight percent of patients (103/152) had pre or postoperative radiotherapy. After the surgical decompression for a spinal 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 patients who could not walk on admission (grade A, B and C of Frankel), 52 % recovered a gait function 3 months post operatively. The best benefit after surgery concerned grade C patients, of which 71 % recovered the gait function. Two percent of the patients had postoperative worsening of their motor strength. No operative mortality was noted, and the postoperative mortality rate was 3 % at 7 days and 9 % at 30 days. The analysis of the actuarial survival curve demonstrated a mean follow up of 3.7 years. The mean survival time was 12 months with 25 % of patients surviving 2 years.

Surgical decompression is effective in relieving neurological symptoms from spinal metastasis. In our experience a complete motor deficit does not seem to be a good surgical indication because of the lack of postoperative improvement.