[Surgical treatment of metastatic spinal malignancies]

The goal of surgical treatment of metastatic tumors of the spine is maintaining the relief of pain and/or neurologic symptoms for as long as possible after surgery. For the quality of life, thirty-five patients were surgically treated. By preoperative analyses, tumor invasion was divided into 3 types as follows; Type 1: involvement of vertebral body, Type 2: involvement of posterior column, Type 3: involvement of anterior and posterior column. Of 35 patients, 31 were in Type 1 or 3, who underwent anterior and/or posterior direct decompression by removal of the tumor, followed by vertebral reconstruction. Posterior surgery was performed on the remaining 4 patients in Type 2, resulting in complete decompression. A combined anterior or posterior instrumentation with anterior reconstruction for the involved vertebral body in Type 1 and 3 provided rigid spinal stability immediately after surgery. Neurologic improvement was evaluated by Frankel's classification. As a result, 4 patients who are alive have been ambulatory for an average duration of 26.3 months. Thirty-one, who survived for an average duration of 10 months, had no neurologic deterioration in an average duration of 8.4 months. Removal of the tumor and reconstructive surgery combined with rigid spinal instrumentation may provide satisfactory results.