gms | German Medical Science

Objective: Five to ten percent of carcinomas with bone metastases show spinal metastases (Barron KD, Hirano A, Araki S, Terry RD 1959; Schaberg J, Gainor BJ. 1985). As the long-term survival of patients with carcinoma is rising, the amount of patients with symptomatic spine metastases increases as well (Quraishi, N. A: et al. 2010). In our department as a maximum care hospital patients present with rapid progressive neurological disorders, which require an urgent decision for therapy. Treatment options range to extensive 360° stabilizations. In our analysis we examined to which extent the patient population benefited from surgery without stabilization.

Methods: We performed a retrospective outcome analysis of electronic patient data from 21 patients (66.67 % male), which were treated for symptomatic spinal metastases by (hemi-) laminectomy between 2009 and 2017. The pre- and postoperative neurological function was evaluated using the ASIA impairment scale, intraoperative data (blood loss, duration of surgery, complications), tumor entities, and staging status. A comparative literature analysis was carried out.

Results: Of 21 patients included, nine (42.86 %) of them suffered from prostate cancer, five (23.81 %) from mamma carcinoma, four (19.05 %) from bronchial carcinoma, and three (14.29 %) from other cancers. The preoperative ASIA score median was C with a mean absolute deviation of 0.63. There was a significant postoperative ASIA score improvement to D (mean absolute deviation of 0.71, sign test p=0.002). According to the SINS there was an indication for stabilization in seven patients. None of them deteriorated with solely dorsal decompression and three of them improved their ASIA score without a stabilizing procedure.

Conclusion: In our patient population a minimal intervention could improve neurological disorders significantly without major complications. Even though there are scoring systems suggesting stabilizing procedures, our results show that a spinal decompression which preserves stability is indicated as well.