Repeat decompression surgery for recurrent spinal metastases

Presented at the 2009 Joint Spine Section Meeting

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Object

In this paper, the authors' goal was to determine the outcome of reoperation for recurrent epidural spinal cord compression in patients with metastatic spine disease.

Methods

A retrospective chart review was conducted of all patients who underwent spine surgery at the Memorial Sloan-Kettering Cancer Center between 1996 and 2007. Thirty-nine patients who underwent reoperation of the spine at the level previously treated with surgery were identified. Only patients whose reoperation was performed because of tumor recurrence leading to high-grade epidural spinal cord compression or recurrence with no further radiation options were included in the study. Patients who underwent reoperations exclusively for instrumentation failure were excluded. All patients underwent additional decompression via a posterolateral approach without removal of the spinal instrumentation.

Results

Patients underwent 1–4 reoperations at the same level. A median survival time of 12.4 months was noted after the first reoperation, and a median survival time of 9.1 months was noted after the last reoperation. At last follow-up 22 (65%) of 34 patients were ambulatory at the time of last follow-up or death, and the median time between loss-of-ambulation and death was 1 month. Functional status was maintained or improved by one Eastern Cooperative Oncology Group grade in 97% of patients. A major surgical complication rate of 5% was noted.

Conclusions

Reoperation represents a viable option in patients with high-grade epidural spinal cord compression who have recurrent metastatic tumors at previously operated spinal levels. In carefully selected patients, reoperation can prolong ambulation and result in good functional and neurological outcomes.

Abbreviations used in this paper: ASIA = American Spinal Injury Association; EBRT = external-beam radiation therapy; ECOG = Eastern Cooperative Oncology Group; ESCC = epidural spinal cord compression; IMRT = intensity-modulated radiation therapy; SRS = stereotactic radiosurgery.

Article Information

Address correspondence to: Mark Bilsky, M.D., Department of Neurological Surgery, Box 71, Memorial Sloan–Kettering Cancer Center, 1275 York Avenue, New York, New York 10021. email: bilskym@MSKCC.org.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    A: Axial MR image obtained in a 67-year-old man with a renal metastasis at L-1 causing high-grade ESCC. B: Postoperative lateral radiograph showing posterior instrumentation spanning T10–L3 and anterior vertebral reconstruction with polymethylmethacrylate and Steinmann pins. C: Axial MR image showing high-grade ESCC caused by tumor recurrence. The patient underwent a reoperation to relieve cord compression.

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    A: Axial MR image obtained in a 68-year-old man with a prostate metastasis at T-10 causing high-grade ESCC. B: Postoperative lateral radiograph showing posterior instrumentation spanning T8–L1. C: Axial MR image showing high-grade ESCC caused by tumor recurrence. The patient underwent a reoperation to relieve cord compression.

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    Kaplan-Meier curve of survival after the last operation.

  • View in gallery

    Kaplan-Meier curve of survival stratified by the number of the last operation that the patients underwent.

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