Role of surgery in the treatment of spinal cord compression by metastatic neoplasm

The results of decompression laminectomy were assessed in a series of 226 patients with compression of the spinal cord by metastatic tumor. The most frequent primary tumor was carcinoma of the breast, which occurred in 16% of patients; tumors of the lung, reticuloendothelial system, sarcomas, and prostate followed in that order. The mortality within 30 days of operation was 8.7%. Ambulatory status was achieved and maintained until death in 36% of patients, and a larger number experienced a gratifying relief of pain and lesser degrees of improvement in neurologic function. The extent of the neurologic deficit at the time of surgery, the type of tumor, and the spinal level of compression all affected the outcome. Prevention remains the best therapy; back pain in a patient with cancer deserves a careful physical examination, spinal roentgenograms, possibly myelography, and prompt treatment with radiation therapy to avoid disabling paralysis. When neurologic dysfunction occurs, surgery is at present the primary form of treatment unless the tumor is highly radiosensitive. The circumstances in which spinal cord compression by metastatic carcinoma can be treated solely by radiation therapy remain to be established.