‘Internal bracing’ surgery in the management of solid tumor metastases of the thoracic and lumbar spine

In patients with thoracolumbar spine metastasis, surgery is aimed at patient healing only when patient has a good prognosis with long life expectancy. In patients with short life expectancy a less aggressive surgical approach of posterior decompression and stabilization could improve patient care and allow for neurological recovery. Thirty-two consecutive patients affected by symptomatic thoracolumbar spine metastases with short life expectancy and good Karnofsky index (50-70) were subjected to surgery and reviewed retrospectively. After tumor embolization, surgery consisted of posterior decompression and stabilization with laminar hooks in the dorsal spine, and laminar hooks or lumbar pedicle screws. Patient's Karnofsky Index, average survival, Frankel neurological status, and pain were recorded before and after surgery, together with surgery related complications. Primary tumors were breast carcinoma (nine patients), renal cell carcinoma (three), lung carcinoma (four), GI tract carcinoma (six), prostate carcinoma (two), carcinoma of the uterus (two), melanoma (three), and malignant tumors at other different sites (three). Average survival after surgery was 23 months, with highest survival rates in renal cancer and breast carcinoma patients, and poorest survival rates in lung and dedifferentiated carcinoma. Karnofsky index improved from average 61 to 72% post-operatively. After surgery patients experienced significant overall improvement of Frankel score and decrease of referred pain. Hospitalization stay was on average 10 days. Results showed that operative treatment of symptomatic spinal metastases in patients with poor prognosis and good general health status improves or preserves neurological function, allows for adjuvant treatments to be performed and has a role in improving general health status in most patients.