Epidural spinal metastases: factors related to selection of cases for decompressive laminectomy

We have treated a selected series of patients with spinal epidural metastatic tumors by dorsal decompression according to principles we presumed would produce the most favorable therapeutic results. There was no operative mortality, and morbidity was minor. In the first postoperative week, improvement in motor function was apparent in 44% of cases. By 3 months postoperatively, 40% of the patients were independently ambulatory and an additional 28% were ambulatory with minimal assistance. This 68% composite compares favorably to the 30 to 40% results in several series of unselected cases. On the basis of this data, it is concluded that consideration of the tumor's histological type, biological history, the host's response, the extent of neurological deficit, the progression of neurological deficit, and dissemination of disease will aid in the definition of those cases with epidural metastases which may be expected to benefit from surgical decompression.