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Surgical Treatment in Patients with Spinal Tumors - Differences in Surgical Strategies and Malignancy-Associated Problems. An Analysis of 474 Patients.

BACKGROUND
Surgical treatment of spinal tumors, especially metastatic disease, is becoming increasingly popular, and its results are encouraging. However, good knowledge of clinical aspects of tumors and surgical techniques is essential. The aim of this paper was to analyze the problems of and differences in surgical strategies for spinal tumor surgery.


MATERIAL AND METHODS
The objectives of this paper were accomplished on the basis of a retrospective evaluation of the surgical records of 474 patients with spinal tumors treated at the Oncological Orthopedics Department in Brzozów in the years 2010-2014. Preoperative and postoperative pain intensity, motor skills and neurological function were evaluated. Surgical strategies, operative approach to the spine, extent of bone resection, methods of filling bone voids and spinal fixation methods were analyzed.


RESULTS
Pain intensity, measured with a VAS scale, decreased in most patients (84%). Motor skills, assessed with the Karnofsky score, improved in 67% of patients. Neurological deficits decreased in 36 out of 105 patients. 369 surgeries were performed from a posterior approach with a preference for long segment fixation. Anterior approach surgeries with tumor resection and implantation of a vertebral body prosthesis or cement were performed in 61 patients. 25 patients with upper thoracic spine pathology were operated from a posterolateral approach. The tumors were resected, prostheses or cement were implanted and transepiphyseal fixation of the spine was performed. Dual-approach surgery was performed in 19 patients, of whom two underwent simultaneous procedures. Laminectomy-associated damage to the dura mater was the most common complication. 34 patients were operated on due to infections of the surgical site. Seven patients died in the perioperative period.


CONCLUSIONS
1. Surgical treatment with adjuvant radiotherapy should be a first-line choice for spinal metastases. 2. Qualification for the procedure involves several factors and should be individualized. 3. The surgical strategy for spinal tumors often differs from general principles of spinal surgery.