RESEARCH – December 2021

Retrospective study of surgically treated patients with spinal metastases at East Tallinn Central Hospital 2004-2016

Authors: Greete Pedai, Taavi Toomela

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Abstract

Background and aim. The main goals of surgical treatment in patients with symptomatic spinal cord sompression (MSCC) are to achieve local tumour control, to decompress neural structures and to stabilize the spine. Surgery is generally considered to be appropriate in patients with an estimated survival of more than 3 months. The aim of this study was to describe the results of surgical treatment in patients with spinal metastases at East-Tallinn Central Hospital (ETCH) in 2004-2016.
Methods. A retrospective study is based on the electronic and written case reports of surgically treated patients with spinal metastases at the ETCH in 2004-2016.
Results. A total of 112 patients with spinal metastases were operated at ETCH from 2004 to 2016. The main primary tumour locations were the breast (21%) and the prostate (13%); Eighteen of the operated patients (16%) had been diagnosed with multible myeloma. Indications for surgical treatment were worsening of neurological deficit (58%), pathological fracture (52%) and single spinal metastasis (10%). In 82 of the cases (73%) a palliative operation of fixation-decompression was done. In 9 patients (8%) a single metastasis was removed `en bloc´. In 21 patients (19%)
some other operation was performed. Seventy-nine (71%) versus 100 (89%) of the patients were able to walk before and after the operation, respectively. Bladder control was preoperatively recorded as normal in 77 (69%) and postoperatively in 90 (80%) of the patients. Serious complications in the early postoperative period were recorded in 16 (14%) of the patients. During the follow-up period ( 6 months to 10 years) 79 patients (71%) died from malignant cancer. One-year cumulative cancer-specific survival was 59 (95%UV 49-67)%. Ninety-seven patients
(87%) survived for at least 3 months after the operation.
Conclusions. The main indications for surgery in patients with spinal metastases are neurological deficit, instability related to pathological fracture, or single spinal metastasis. Operations are mostly palliative with the objective to improve or maintain the quality of life.