Microsurgery of the cervical spine in elderly patients. Part 2: Surgery of malignant tumourous disease.

In this retrospective study, the results of surgery were examined in 25 patients, 65 years of age or older, suffering from malignant tumour growth along the cervical spine. The group consisted of 17 men and 8 women. The mean age was 73 years, ranging from 66 to 88 years. The pathology identified was metastasis in 23 patients, and plasmocytoma in two. The tumour localization involved a single segment of the cervical spine in 12 patients, two segments in 8 patients, three segments in 4 patients, and four segments in one patient. Pre-operatively, 8 patients (32%) suffered solely from severe pain. 6 patients (24%) showed severe pain and radicular nerve compression. 5 patients (20%) had incomplete para- or tetraparesis but were able to walk, and again 6 patients (24%) had incomplete para- or tetraparesis, and were unable to walk. A multitude of accompanying systemic diseases was present in the majority of patients. Evaluation of the peri-operative risk profile was performed using the American Society of Anaesthesiology (ASA) Grading of Physical Status Score. Operation consisted of microsurgical tumour removal, usually incorporating a single- or multi-level vertebrectomy, with radical epidural decompression, and grafting with bone cement followed by an appropriate osteosynthesis. Of the whole cohort of patients treated, four patients were still alive at the time of the last follow-up evaluation. 21 patients died. Four patients died within seven days after surgery. The remaining 17 patients died during the follow-up period. All of these patients died from systemic spread of their primary cancer.(ABSTRACT TRUNCATED AT 250 WORDS)