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% recovery rate.
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 was unsuccessful."