Outcome of Palliative Single Posterior Reconstruction Surgery for Metastatic Spinal Tumor

Metastatic spinal tumor has been reported to occur in approximately 30% of cancer patients. The distribution of lesions is 10% in cervical spine, 20% in lumbar spine and 70% in thoracic spine. Five percent of metastatic spinal tumor is reportedto cause epidural compression, giving rise to clinical symptoms such asparalysis and pain. These symptoms can lead to deterioration of patients’ daily activities. The therapeutic choice for these patients should be based on clinical information such as the extent of metastasis, degree of malignancy, general condition of the patient, and estimated life expectancy.

Tokuhashi et al. reported a scoring system for pre-operative evaluation of prognosis of metastatic spine tumor. In their paper, prognosis evaluation was based on the opinion of oncologist and the pre-operative prognostic score. They suggested that excisional procedures are indicated in patients with a total score from their scoring system of 12 or more (predicted survival period, 1 year or longer), while conservative or palliative procedures are indicated on patients with a total score of 8 or less (predicted survival period, less than 6 months). Tomita et al. also described a scoring system, with corresponding treatment proposals, for patients with spinal metastasis. It was based on three prognostic factors: (1) grade of malignancy, (2) presence of visceral metastasis, and (3) presence of bone metastases. Their strategy for each patient was decided along with treatment goal: a wide or marginal excision for long-term local control, marginal or intralesional excision for medium-term local control, palliative surgery for short-term palliation, and non-operative supportive care.(Read More)