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Anesthesia for Spinal Decompression for Metastatic Disease

Until recently, it has been widely believed that when patients with malignant disease develop neurologic symptoms due to spinal metastases progress of the condition is irreversible and surgery is futile. Thus, surgery of this type has been unusual, and the special problems associated with anesthesia for this heretofore relatively rare operative procedure have not been documented. However, because the contiguity of the Wellesley Hospital to the Ontario Cancer Institute enables a rapid consultation, smooth transport, and prompt surgery, approximately 250 patients with neurologic deterioration caused by spinal metastatic disease have undergone decompressive surgery at the Wellesley Hospital over the past 10 years. These patients typically have had previous treatment for cancer, most commonly of the breast or prostate, have often been symptom-free for many years, and have gradually or suddenly developed back pain, paraparesis, or paraplegia, often with loss of sphincter control. Surgery may be indicated because of the rapid progression of symptoms in spite of radiotherapy, or because of encroachment by metastases on the vertebral structure, potentially with fracture-dislocation. Surgery involves spinal laminectomy with removal of the metastatic tissue compressing the spinal cord. Stabilization of the vertebral column with instrumentation, wiring, or prosthetic cement may be required, depending on the extent of skeletal destruction. Analysis of the first 150 cases performed at Wellesley Hospital showed that after surgery, 75% of patients had significant relief of pain, 66% became ambulatory, 16% had significant return of motor function, and 43% remained ambulatory and continent 6 months after surgery (1).