Operative management of epidural tumors of the spine

Seventy-two patients with neoplastic involvement of the vertebral column were operated on between 1986 and 1991. In the course of 79 operations anterior decompression and stabilization alone were performed in 3 cases, while ventrodorsal spondylodesis was carried out in 10 individuals. The remainder of the patients underwent exclusively dorsal decompression and stabilization, mainly with the Cotrel-Dubousset instrumentation (CDI). No external spinal support was required following posterior fixation by CDI alone or in combination with ventral spondylodesis. Forty patients suffered from neurological deficits preoperatively, 20 of them being unable to walk, in most cases owing to severe vertebral collapse. Neurologic symptoms improved in 18 patients postoperatively. Median postoperative survival time averaged 11.5 months. In palliative surgery of the spine, posterior decompression and fixation using CDI permit most patients to retain ambulation without requiring external orthotics. The rate of postoperative complications is reduced by the introduction of CDI.