Decompression and surgical stabilization in the palliative treatment of vertebral metastases

Instability of the spine consequent to the diffusion of a primary tumor is a serious complication in cancer patients. The experience of our Service in the surgical treatment of vertebral metastases is reported. Since 1990, 21 patients have undergone surgery. The vertebral metastases were localized at the cervical level in 4 cases, thoracic in 13, and lumbar in 4. Pain was the first symptom in 18 patients. The necessary criterion for intervention was intractable severe pain and/or neurologic deficit. At the thoracic and lumbar levels (17 cases) a posterior approach was always used to perform wide decompressive laminectomy and to stabilize the spine. An anterior approach is unadvisable in light of the risk related to the operation and the long recovery time. In 13 cases Cotrel-Dubousset bars were utilized, in 3 cases Roy-Camille, and in 1 case Louis plates. After surgery, significant pain relief was noted in 85% of patients. Of those with neurologic deficit, improvement in neurologic status was seen in 50%; in 28% neurologic deficit was completely resolved. We conclude that, although palliative, wide laminectomy accompanied by stabilization is a satisfactory treatment of vertebral metastases. Given the appropriate indications, surgical treatment improves the patient's quality of life.