Treatment of tumors of the thoracic and lumbar spinal column.

From December 1981 to February 1986, 33 patients with tumorous conditions of the spine were treated with anterior, posterior, or combined anterior and posterior surgical techniques. Breast metastases were by far the most common condition, accounting for more than 51% of patients with metastatic spinal disease. The surgeon treating tumorous conditions of the spine must be aware that, to date, the treatment is palliative only. The goals of the surgery and treatment are to reduce pain, preserve or improve neurologic function, and allow early mobilization. Survival overall averaged 9.1 months. Of the 14 patients who had anterior decompression alone, average survival time was 9.9 months. The 14 patients who had posterior procedures had an average survival time of 11.9 months. Five patients treated with combined anterior and posterior procedures survived 9.6 months. Fifteen patients with multiple-level spinal involvement survived 7.9 months, compared with 12.9 months for the 18 patients with single-level spinal involvement. Aggressive surgical treatment definitely improves the quality of life of patients with cord compression or unstable spinal segments secondary to bony destruction. An aggressive approach is indicated because it permits most patients to spend the remainder of their lives relatively pain-free and with intact spinal cord function.