[Surgical treatment of spinal metastases]

Spinal metastasis often lead to two main complications: back pain and para or tetraplegia. Performed alone radiotherapy may be too slowly efficient to allow a neurological recovery. Laminectomy may improve the neurological signs but does not induce any change on root pain and it increases instability. A surgical procedure by a posterior approach including laminectomy and fixation by plates and transpedicular screws fits these two goals: decompression and stabilisation. The first 189 cases are reported: the first month lethality is about 15%. 81% of fixations remained unchanged. 21 out of the 62 patients with loss of autonomy recovered an ability to walk. Besides this palliative surgery, a total spondylectomy has been done 13 times in order to perform a curative surgery for unique metastasis of cancers with long life expectancy. An early walking is often possible and after healing of the wound, a complementary treatment with radio or chemo therapy may be started without any risk of pain or neurological compression.