外科ジャーナル

Therapy of Spine Metastasis Causing Paralysis Symptoms – Operation and Rehabilitation

Abstract

Lars Homagk, Pataraia A and Röhl K

Most common manifestation of tumor metastasis after lungs and liver is the skeletal system with 60-80% of spine metastasis. In 30% of all cancer patients with metastatic spinal complaints are initial presentation of malignant primary disease while the primary paraplegia occurs in 5-10% of all spinal metastases. Thus a further operational metastases treatment is dependent on the entire metastasis status, the type and Tomita score as well as the risk of surgery considering general patient status. From 01.01.11 to 31.12.12 we included 16 patients with tumors. In 27% of the cases the first symptoms were paraplegia, but the primary tumor was determined in only one of these cases. 73% of patients underwent surgical treatment within the first 24 hours after admission. The hospital stay was 22 days. 56.3% of patients had incomplete paralysis at admission and 71% of these patients had postoperative improvement in neurological outcomes. All patients benefited as part of operational and rehabilitative treatment of a significant reduction in pain and 50% of patients were able to be discharged home. At the onset of paralytic symptoms we recommend immediate operation. In a multidisciplinary case conference the oncological treatment regimens should be defined also for the necessary paralysis treatment. Decision guidance is the height of paralysis, tumorgenesis, ASA classification and the pain symptoms of the patient. The treatment must adjusted and individualized according to the patient's general health, life expectancy, the primary tumor, the grading of metastasis and extent of neurological deficit.