Decision Making for the Surgical Treatment of Vertebral Metastases Among Patients with Short Predicted Survival.

BACKGROUND: A wide spectrum of treatment choices is proposed for poor-prognosis patients with vertebral metastases. The continuous increase of this population and the propagation of less invasive techniques necessitate further study concerning which patients could benefit from palliative surgery.

METHODS: All patients with a Tokuhashi score ≤8 who had undergone palliative surgical treatment for vertebral metastasis within 4 years were retrospectively reviewed. Demographics, clinical characteristics, and data concerning the disease and the operation were recorded. Patients were assessed on discharge and at 2 months concerning eventual benefit from surgery, based on pain measurements, motor function (Frankel grade), spinal stability assessment, and complications. Statistical analysis was performed to detect possible interrelations.

RESULTS: Eighty-eight patients were reviewed. The average age was 56.5 years. The mean Tokuhashi score was 5.9, and the mean Karnofsky score was 56.4. Thirty-six patients experienced immediate improvement, 12 were lost to follow-up, and 42 were found to have benefited from surgery 2 months later. High Karnofsky score, radicular pain, morphine use, absence of complications, and immediate improvement predicted benefit from surgery.

CONCLUSIONS: Decision making for a patient with poor prognosis concerning eventual surgery for a vertebral metastasis should be based mainly on the patient's clinical presentation; the primary cancer site is of less importance.