HOUSTON--Combining spinal stabilization with currently used surgical
procedures is producing improved results in spinal cord compression patients,
Ziya Gokaslan, MD, a neurosurgeon at The M.D. Anderson Cancer Center, reported
at a symposium on cancer and the central nervous system.
"Surgical decompression, along with spinal stabilization, is currently
the foremost therapeutic modality for patients with significant neurological
compromise and instability resulting from radioresistant tumors,"
Dr. Gokaslan said.
Spinal cord compression occurs in about 20% of patients with spinal
metastases. Most patients experience significant pain requiring immediate
relief. Until recently, radiotherapy or laminectomy plus radiotherapy were
the primary treatments for spinal cord compression; both provide a 40%
New developments have improved the response to various other surgical
procedures. These include improvements in spinal reconstruction techniques
and the introduction of instrumentation that facilitates more precise access
to and manipulation of tumors of the spine.
Higher Recovery Rates
In recent studies, combining laminectomy or vertebrectomy (vertebral
body replacement) with spinal cord stabilization has significantly increased
neurological recovery rates: Rates of 66% have been reported with laminectomy
plus stabilization, and 74% with vertebrectomy plus stabilization. In addition,
these procedures provided 80% to 90% pain relief. "This shows spinal
stabilization to be integral to the surgical management of cord compression,"
Dr. Gokaslan said.
However, each case is different, and an individualized treatment plan
should be applied. Said Dr. Gokaslan: "Radiotherapy is still the recommended
first-line therapy, specifically in cases where the tumor is radiosensitive,
there is no instability or bone compression, and the patient is neurologically
stable. Otherwise, surgery is indicated, particularly if prior radiotherapy