Laminectomy for metastatic epidural spinal cord tumors. Posterior stabilization, radiotherapy, and preoperative assessment.

In a retrospective analysis of 149 patients with metastatic spinal tumors, the postoperative outcome was compared in patients who had posterior decompressive laminectomies alone (PL) and patients who had supplemental posterior stabilization at the time of laminectomy (PLS). The object of the analysis was to define the indications for stabilization. Posterior stabilization relieved pain, improved sphincter function, and encouraged ambulatory status. The use of adjunctive radiotherapy preceding laminectomy did not significantly improve the patient's postoperative course. Sex, age, initial symptom, length of time from onset of initial neurologic symptom to the time of laminectomy, the presence or duration of pain or sensory loss, the number of vertebrae involved with tumor, and the presence of widespread metastatic disease did not seem to influence the results of the surgical treatment. The presence of significant motor dysfunction, which was rapidly progressive before surgery, or profound sphincteric dysfunction prior to decompressive laminectomy was more frequent in patients who had unsatisfactory results. Decompressive laminectomy with stabilization should be considered in patients: with progressive neurologic symptoms, who are ambulatory, but whose pain increases despite radiotherapy, and who are ambulatory and were receiving radiotherapy for pain relief but who display neurologic dysfunction. For patients with established paraplegia and sphincter dysfunction, decompressive laminectomy and posterior stabilization are adjunctive measures of pain control.