Surgery in Spinal Metastasis - Was it Worth it?

Materials and Methods: We reviewed 54 surgical interventions in 48 cases of symptomatic spinal metastasis operated between May 1993 and May 2002. Outcome was based on analysis of hospital medical records and telephonic interviews. Assessment of results was made at an average of 3 1/2 years post op. All patients had spinal instability, and 28 cases presented with neurological deficit of varying grades. 17 underwent pre operative digital subtraction angiography and embolisation was carried out in 10. Anterior surgery was performed in 16, Posterior surgery in 34 patients and combined approach was used in 4. 5 patients underwent a repeat surgical intervention after a good pain free and functional period. The average blood loss was 700 cc .The average duration of surgery was 4 hrs.

Results: Mean post operative survival was 11 months. This survival statistic makes a strong case for surgery in these patients. Over 80 % of our 48 patients were satisfied with pain relief. This statistic was based on patients / next of kin's response to direct questions. Neurological recovery was observed in 30 % of the 28 cases with pre operative neurological deficit. There were no major anaesthetic complications in any of the patients. One patient had a surgical complication in the form of a pharyngeal fistula following anterior cervical spine surgery.

Conclusions: Surgical intervention in metastatic disease of the spine has definite advantages of pain relief and return to function in a select group of patients. A fairly long life expectancy in most cases with spinal mets, makes a case for intervention to improve the quality of remaining life.