Surgical management of metastatic disease of the lumbar spine: experience with 139 patients.

Paul J. Holman, Dima Suki, Ian McCutcheon, Jean Paul Wolinsky, Laurence D. Rhines, Ziya L. Gokaslan

Research output: Contribution to journalArticle

Abstract

OBJECT: The surgical treatment of metastatic spinal tumors is an essential component of the comprehensive care of cancer patients. In most large series investigators have focused on the treatment of thoracic lesions because 70% of cases involve this region. The lumbar spine is less frequently involved (20% cases), and it is unclear whether its unique anatomical and biomechanical features affect surgery-related outcomes. The authors present a retrospective study of a large series of patients with lumbar metastatic lesions, assessing neurological and pain outcomes, complications, and survival. METHODS: The authors retrospectively reviewed data obtained in 139 patients who underwent 166 surgical procedures for lumbar metastatic disease between August 1994 and April 2001. The impact of operative approach on outcomes was also analyzed. Among the wide variety of metastatic lesions, pain was the most common presenting symptom (96%), including local pain, radicular pain, and axial pain due to instability. Patients underwent anterior, posterior, and combined approaches depending on the anatomical distribution of disease. One month after surgery, complete or partial improvement in pain was demonstrated in 94% of the cases. The median survival duration for the entire population was 14.8 months. CONCLUSIONS: The surgical treatment of metastatic lesions in the lumbar spine improved neurological and ambulatory function, significantly reducing axial spinal pain; results were comparable with those for other spinal regions. Analysis of results obtained in the present study suggests that outcomes are similar when the operative approach mirrors the anatomical distribution of disease. When lumbar vertebrectomy is necessary, however, anterior approaches minimize blood loss and wound-related complications.

Original languageEnglish (US)
Pages (from-to)550-563
Number of pages14
JournalJournal of Neurosurgery: Spine
Volume2
Issue number5
StatePublished - May 2005
Externally publishedYes

Fingerprint

Disease Management
Spine
Pain
Survival
Neoplasms
Patient Care
Thorax
Therapeutics
Retrospective Studies
Research Personnel
Outcome Assessment (Health Care)
Wounds and Injuries
Population

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Neurology

Cite this

Holman, P. J., Suki, D., McCutcheon, I., Wolinsky, J. P., Rhines, L. D., & Gokaslan, Z. L. (2005). Surgical management of metastatic disease of the lumbar spine: experience with 139 patients. Journal of Neurosurgery: Spine, 2(5), 550-563.

Surgical management of metastatic disease of the lumbar spine : experience with 139 patients. / Holman, Paul J.; Suki, Dima; McCutcheon, Ian; Wolinsky, Jean Paul; Rhines, Laurence D.; Gokaslan, Ziya L.

In: Journal of Neurosurgery: Spine, Vol. 2, No. 5, 05.2005, p. 550-563.

Research output: Contribution to journalArticle

Holman, PJ, Suki, D, McCutcheon, I, Wolinsky, JP, Rhines, LD & Gokaslan, ZL 2005, 'Surgical management of metastatic disease of the lumbar spine: experience with 139 patients.', Journal of Neurosurgery: Spine, vol. 2, no. 5, pp. 550-563.
Holman PJ, Suki D, McCutcheon I, Wolinsky JP, Rhines LD, Gokaslan ZL. Surgical management of metastatic disease of the lumbar spine: experience with 139 patients. Journal of Neurosurgery: Spine. 2005 May;2(5):550-563.
Holman, Paul J. ; Suki, Dima ; McCutcheon, Ian ; Wolinsky, Jean Paul ; Rhines, Laurence D. ; Gokaslan, Ziya L. / Surgical management of metastatic disease of the lumbar spine : experience with 139 patients. In: Journal of Neurosurgery: Spine. 2005 ; Vol. 2, No. 5. pp. 550-563.
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