gms | German Medical Science

Objective: Space-occupying spinal metastases are commonly diagnosed due to acute neurological deterioration and consequently, immediate decompression with tumor removal or reduction is performed. Here, we report our experience and analysis of our series of patients with surgically treated spinal metastases. We explicitly sought to determine individual predictors of functional outcome.

Methods: 95 consecutive patients (27 women, 68 men; mean age 64.0 years) with spinal metastases were included retrospectively. All patients were treated surgically in our department. We reviewed the charts, surgical reports and radiographic data for demographics, duration of symptoms, histopathology, stage of systemic disease, co-morbidities, radiographic extension, surgical strategy and neurological performance pre- and postoperative. The median follow-up was 1.4 months..

Results: Prostate carcinoma (29.5%) and breast carcinoma (11.6%) were the most common histopathologies. KPI was < 70 % in more than 50% of the cases at admission and improved significantly until discharge. Emergency surgery (<24 hrs) was performed in 38%. Rates of complications and revision were 9.4% and 4.2%, resp. From admission to discharge we encountered significant pain reduction (p= 0.019) and significant improvement motor deficits (p= 0.003). The ASIA Impairment Scale and the Brice McKissock Score showed a significant improvement during in hospital treatment (p=0.05; p=0.049). In the multivariate analysis emergency surgery was a significant predictor for persisting neurological deficits at time of discharge, whereas a solitaire metastasis was a predictor for improved.

Conclusion: Decompression with tumor removal or reduction in patients with space-occupying spinal metastases led to a good functional neurological outcome and had a beneficial impact on pain and impairment. However, patients with acute severe onset of neurological deficits due to multiple spinal metastases had a higher risk poor neurological outcome.