[Clinical picture of malignant extradural tumors of the spine].

The postoperative prognosis of malignant extradural spinal tumours still is unfavourable with regard to both functional restitution and postoperative survival time. Short anamnestic times and severe neurological attacks developing within a short period of time up to a complete transverse paraplegia syndrome characterise the clinical picture. In addition to the usually existing increase in the lumbar cerebrospinal protein level (86 per cent), pathological native X-ray findings are found condierably more frequently than in processes of other topical localisations (72 per cent). In three quarters of the cases the pantopaque myelogram shows complete contrast medium passage disturbances. In 10.8 per cent of the cases, an improvement of the findings could be achieved by an operation, 76.9 per cent showed an unchanged condition up to four weeks post operationem and in 12.3 per cent a deterioration of the condition had occurred. The average survival times of the deceased patients was 4.1 months. Prolonged survival times between three and six years were only seen in two retothelial sarcoma patients and one sarcoma patient. The cause of the unfavourable functional results are believed to be due to medullary circulation disturbances which are caused by the tumour and can non longer be influenced by an operation. In spite of the results being frequently unfavourable, a general rejection of the operation does not seem to be justified. It should, however, be rejected when (I) a complete transverse lesion syndrome has been present for several months, (2) extensive vertebral destruction can be demonstrated, (3) multiple destruction foci are present and (4) there ist an advanced stage of the primary process with a highly reduced general condition.