New Methods Improve Results in Spinal Cord Compression

HOUSTON--Combining spinal stabilization with currently used surgicalprocedures is producing improved results in spinal cord compression patients,Ziya Gokaslan, MD, a neurosurgeon at The M.D. Anderson Cancer Center, reportedat a symposium on cancer and the central nervous system.

"Surgical decompression, along with spinal stabilization, is currentlythe foremost therapeutic modality for patients with significant neurologicalcompromise and instability resulting from radioresistant tumors,"Dr. Gokaslan said.

Spinal cord compression occurs in about 20% of patients with spinalmetastases. Most patients experience significant pain requiring immediaterelief. Until recently, radiotherapy or laminectomy plus radiotherapy werethe primary treatments for spinal cord compression; both provide a 40%recovery rate.

New developments have improved the response to various other surgicalprocedures. These include improvements in spinal reconstruction techniquesand the introduction of instrumentation that facilitates more precise accessto and manipulation of tumors of the spine.

Higher Recovery Rates

In recent studies, combining laminectomy or vertebrectomy (vertebralbody replacement) with spinal cord stabilization has significantly increasedneurological recovery rates: Rates of 66% have been reported with laminectomyplus stabilization, and 74% with vertebrectomy plus stabilization. In addition,these procedures provided 80% to 90% pain relief. "This shows spinalstabilization to be integral to the surgical management of cord compression,"Dr. Gokaslan said.

However, each case is different, and an individualized treatment planshould be applied. Said Dr. Gokaslan: "Radiotherapy is still the recommendedfirst-line therapy, specifically in cases where the tumor is radiosensitive,there is no instability or bone compression, and the patient is neurologicallystable. Otherwise, surgery is indicated, particularly if prior radiotherapywas unsuccessful."