Posterior decompression and stabilization for metastatic compression of the thoracic spinal cord:: is this procedure still state of the art?

Study Design: Retrospective study utilizing the standard patient data documentation of a spinal cord injury (SCI) unit. Objective: To examine the efficacy and outcome of posterior decompression and stabilization for metastatic cord compression. Setting: Orthopedic university hospital with large SCI unit. Methods: The 34 consecutive patients who had presented with symptoms of spinal cord compression due to metastatic disease and progressive neurologic deficit were treated using a uniform surgical approach (posterior decompression and stabilization). After surgery, all treatment options available in a full-featured SCI unit were applied as necessary and suitable. Outcome was rated concerning neurologic function (American Spinal Injury Association, ASIA), functional status (Functional Independence Measure) and pain. The results were compared to the published results, focusing on publications describing results of anterior surgical approaches to the spine. Results: Evaluation of the results of the ASIA exams showed that progression of the neurologic deficit could be stopped in the majority of cases - however recovery of neurologic function was rare. The functional status could be improved markedly and good pain reduction was achieved. Conclusion: Immediate surgery can be recommended if the general condition of the patient warrants surgical intervention. Using accepted standards of documentation for SCI, a clear perspective of the results that can be expected is provided. Comparing the results of this study with the current literature there is no evidence that anterior approaches are superior.