[Neurological findings in patients treated surgically for spinal metastatic disease]

We present a group of patients with spinal metastatic disease surgically treated at our department, with an evaluation of their neurological outcomes in relation to the initial disease and the surgical technique used.

Between 1989 and 2007 we operated on 748 patients with spinal tumour. Of these, 380 had metastatic disease. The Frankel classification system was used to assess neurological status.

Based on the Tomita prognostic score, the metastatic disease was evaluated and appropriate surgical procedure was selected (biopsy, posterolateral decompression, posterolateral decompression with stabilisation, somatectomy, or vertebrectomy/spondylectomy). The neurological findings before and after surgery and at follow-up were assessed.

Of the 368 patients evaluated, four were pre-operatively classified as Frankel grade A, 29 as grade B, 99 as grade C, 82 as grade D and 159 patients as grade E. Post-operative outcomes were: Frankel grade A, 6 patients B, 27 C, 78 D, 79 and E, 178 patients. Surgery resulted in neurological deterioration by 3 degrees of the Frankel scale in two patients (0.5%), 2 degrees in three patients (0.8%), and by 1 degree in 17 patients (4.6%). Improvement was recorded: by 1 degree in 57 patients (15.5%), 2 degrees in 10 (2,7%) and 3 degrees in two patients (0.5%). Of 23 patients who underwent biopsy, neurological status improved in one (4.3%) and deteriorated also in one patient (4.3%). Of the 85 patients treated by posterolateral decompression, improvement was recorded in 25 (29.4%) and deterioration in two (2.4%). Of the 73 patients undergoing posterolateral decompression with stabilisation, neurological findings improved in 15 (17.9%) and deteriorated in five (6.0%). In the group of 103 patients treated by vertebrectomy, neurological findings improved in 13 (12.6%) and deteriorated in eight (7.8%). At an average follow-up of 15 months, 208 (55.7%) patients presented themselves of these, improvement in neurological status was recorded in 16 (7.8%) and deterioration in eight (3.9%), as compared with the pre-operative values.

Any comparison with the literature data is difficult, because both the criteria of indication for surgery and the method of treatment differ considerably. Improvement in neurological status was achieved in 69 patients (18.8%).

Metastatic tumours of the spine present a serious diagnosis, with pain often being the first sign of a malignant disease. The degree of neurological deficit, primary tumour site and the extent of metastatic spinal disease (objectively evaluated on the basis of the Tomita score) should determine whether the patient will be operated on or not and, if so, whether a radical or mere palliative procedure will be used. An important factor is multidisciplinary cooperation of attending physicians both preoperatively and during the post-operative care of cancer patients.