Anterior decompression and stabilization of the spine in malignant disease

Evidence has accumulated that indicates that laminectomy with or without radiotherapy is not necessarily the best mode of treatment for all cases of spinal cord compression of malignant pathogenesis. Success is limited, and there is a high risk of adverse neurological developments, particularly where there is anterior vertebral collapse. A prospective series of 26 consecutive patients with neurological complications of neoplastic extradural cord compression is described. Anterior decompression followed by stabilization in a single stage procedure was selected as the most appropriate method of treatment for all 26 patients. Various techniques were used in the replacement of the excised vertebral body, including the use of two types of prosthesis created specifically for the purpose. Of the patients who were not ambulatory at the time of surgery, 62% became so postoperatively; 71% of those with intractable pain were pain free after surgery. The postoperative mortality rate was 30%, which reflected the poor condition of the patients; in light of this, the criteria for operative selection are reviewed. Neurological deterioration did not occur in any patient. The method is recommended, for selected patients, for the management of cord compression caused by collapse of the vertebral body. The patient's prospects of restored ability to walk after a single-stage operation are good, and the risk of adverse neurological effects is negligible.