Spinal epidural neoplasia. A 15-year review of the results of surgical therapy.

The outcome following decompressive laminectomy and spinal irradiation has been evaluated in 104 consecutive patients with epidural metastatic neoplasia, using broad criteria for successful outcome. Of patients so treated, 33% were benefited, while 23% became worse. Both tumor histology and the preoperative neurological status were important factors in determining the response to this therapy. The authors review the surgical and radiotherapeutic literature in the treatment of this condition, and conclude that there is no clearly established superiority of laminectomy followed by irradiation over radiotherapy alone. Specific indications for surgery exist if prior histological confirmation of malignancy is lacking, if there is neurological deterioration during radiotherapy, or if there are recurrent symptoms referable to a previously irradiated metastasis. Surgery is also indicated if facilities for prompt administration of radiotherapy are unavailable.