Surgery in spinal metastasis without spinal cord compression: indications and strategy related to the risk of recurrence

Surgery in patients presenting with vertebral metastasis without neural deficit is controversial. A series of 107 patients (54 female, 53 male) were operated on at a mean age of 58. The metastasis was the first manifestation of the cancer in seven cases. In 100 patients, the cancer had been diagnosed 30 months earlier (average). Vertebral pain was present in all cases, with associated radicular pain in 43 cases. Pyramidal irritation without neural deficit was present in seven cases. The mean preoperative Karnofsky index was 64.7%. The mean preoperative Tokuhashi score was 8.6. The surgical approach depended on the topography of the metastasis. Ninety-three patients were dead at review, with a mean survival of 8 months. Seventeen patients underwent further spinal surgery, for local recurrence in nine cases, and for another spinal localization in eight cases, after a mean interval of 8 months. Recurrence occurred at the same level in all seven patients presenting with neural deficit at recurrence. Among ten recurrences without neural deficit, two were observed at the same level and eight were observed on another level. Surgery in vertebral metastasis without neural deficit results in substantial functional improvement, but does not increase the duration of life. For kidney metastasis, total vertebrectomy must be performed because of the risk of recurrence. For thyroid metastasis, total vertebrectomy is a good alternative to increase the efficacy of iodotherapy. In other cases, for patients with good general status, surgery must be adapted to the location of the involvement.