Microsurgery of the Cervical Spine in Elderly Patients Part 2: Surgery of Malignant Tumourous Disease
Acta Neurochir (Wien) (1994) 131: 241-246，-0001，（）：
In this retrospective study, the results of surgery were examined in 25 patients, 65 years of age or older, suffcring from malignant tumour growth along the cervical spine. The group consisted of 17 men and 8 women. The mean age was 73 years, ranging from 66go 88 years. The pathology identified was medtastasis in 23 patients, and plasmocytoma in two. The tumour localization involved a single segment of the cervical spine in 12 patients, two segments in 8 pa-tients. three scgments in 4 patients, and four segments in one patient. Pre-operatively, 8 patients (32%) suffered solely from severe pain. 6 patients (24%) showed severe pain and radicular nerve compres-tion. 5 patients (20%) had incomplete parta or tetraparesis but were able to walk, and again 6 paticnts (24%) had incomplete para of tetraparesis, and were unable to wald. A multitude of accompanying systemic diseases was present in the majority of patients. Evaluation of the pcri-operative risk profile was parformed using the American Socicty of Anaesthesiology (ASA) Grading of Physical Status Score. Operation consisted of microsurgical tumour removal, usually in-corporationg a single or multi-level vertebrectomy, with radical epi-dural decompression, and grafting with bone cement followed by an ippropriate osteosynthesis. Of the whole cohort of patients treated, four patients were till alive at the time of the last follow-up evaluation. 21 patients did. Four patients died within seven days after surgery. The remaining 17 patients died during the follow-up period. All of these patients died from systemic spread of their primary cancer. The results of mrgery in terms of postoperative neurological outcome were as Fol-lows: 11 patients or 44% were improved by surgery. 7 patients (28%) were unchanged, three patients (12%) became worse, and four pa-tents (16%) died. With regard to functional outcome, 73% of the patients with severe pre-operative neurological deficits showed sig-inficant postoperative amelioration of symptoms. 19 patients became imbulatory until the final sage of their disease. It is concluded, that according to the results of this limited study, general nihilistic or purely conservative approach for the treatment of elderly patients suffering from secondary malignancy of the cer-vical spine is not justified. With proper patient sclection, aggressive mrgery leads to significant amelioration of pre-operatively existing neurological deficits and long-term ambulation in a considerable percentage of the patients.