Palliative surgery for metastatic thoracic and lumbar tumors using posterolateral transpedicular approach with posterior instrumentation.

BACKGROUND: The purpose of this study was to evaluate the clinical outcomes of patients with metastatic thoracic and lumbar tumors after palliative surgery using PTA with posterior instrumentation.

METHODS: Twenty-one consecutive patients with metastatic thoracic and lumbar spine tumors were treated using a PTA with posterior instrumentation. The patient group is composed of 14 men and 7 women with mean age of 56.6 years (range, 32-76 years). The average extent of vertebral involvement was 2.2 segments.

RESULTS: The mean operative time was 3.1 hours (range, 2-4.5 hours), and the mean blood loss was 1400 mL (range, 600-2500 mL). All patients with pain showed improved or similar pain levels after surgery, and Frankel grades were decreased significantly by operation. Postoperative mean survival was 8.9 months and ranged from 2 to 36 months. There were 4 (26.7%) patients who died at less than 3 months after surgery and 3 patients (14%) who required a repeat operation. Of 5 patients treated using a PTA despite a Tomita's prognostic score of more than 8, 3 patients (with preoperative ECOG grade IV) died within 6 weeks postoperatively, and the other 2 patients (with preoperative ECOG grade III) survived longer than 10 weeks (1 patient survived for 10 weeks, and the other for 12 weeks).

CONCLUSION: The PTA with posterior instrumentation for metastatic thoracic and lumbar spinal tumors achieved good surgical results. Palliative surgery for patients with a Tomita's prognostic score of more than 8 may be considered in selected cases, especially in those with ECOG grade III.