Intradural spinal metastases: A surgical series of 15 patients

Jason M. Hoover, William E. Krauss, Giuseppe Lanzino

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background Intradural spinal metastases are rare, and little is known regarding surgical indications and outcomes. Methods A retrospective search identified adults with intradural spinal metastases operated on at the Mayo Clinic from 1994-2011. Data were collected regarding demographics, tumor type and location, and outcomes. Results Fifteen patients with intradural spinal metastases were investigated. The age range was 38-74 years (mean0 55 years; ±SD011.1). Predominant tumor location and type were lumbosacral and adenocarcinoma, respectively: 3 intramedullary and 12 extramedullary. Patients were operated on to relieve or prevent progressive/intractable neurological sequelae and/or pain. Of 13 who underwent resection, gross total removal was reported in 10; simple biopsy was performed in 2. There was one surgical complication, no medical complications, and no surgical mortality. At median follow-up of 1 month postoperatively, 10 of 15 patients were stable or improved. Of 13 patients who underwent resection, 10 were stable or improved. Of two patients who underwent biopsy, neither was stable or improved at follow-up. Using the Modified McCormick Scale, 11 of 15 patients were " functional" preoperatively and 4 went from "functional" preoperatively to "non-functional" postoperatively. Three of those four died within 60 days of surgery from systemic disease progression. Median hospital stay was 8 days. Ten of 15 patients died by the end of the study period, and the median survival of 15 patients was 5 months. Conclusions With improved outcomes in metastatic cancer, more patients are encountered in practice. An aggressive surgical approach is warranted for extramedullary lesions, whereas caution is advised for intramedullary lesions. Postoperative functional decline is more likely due to systemic disease progression rather than surgery.

Original languageEnglish (US)
Pages (from-to)871-877
Number of pages7
JournalActa Neurochirurgica
Volume154
Issue number5
DOIs
StatePublished - May 2012

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Neoplasm Metastasis
Disease Progression
Biopsy
Neoplasms
Ambulatory Surgical Procedures
Length of Stay
Adenocarcinoma
Demography
Pain
Survival
Mortality

Keywords

  • Intradural
  • Metastasis
  • Spine
  • Surgery

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)
  • Clinical Neurology

Cite this

Intradural spinal metastases : A surgical series of 15 patients. / Hoover, Jason M.; Krauss, William E.; Lanzino, Giuseppe.

In: Acta Neurochirurgica, Vol. 154, No. 5, 05.2012, p. 871-877.

Research output: Contribution to journalArticle

Hoover, Jason M. ; Krauss, William E. ; Lanzino, Giuseppe. / Intradural spinal metastases : A surgical series of 15 patients. In: Acta Neurochirurgica. 2012 ; Vol. 154, No. 5. pp. 871-877.
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N2 - Background Intradural spinal metastases are rare, and little is known regarding surgical indications and outcomes. Methods A retrospective search identified adults with intradural spinal metastases operated on at the Mayo Clinic from 1994-2011. Data were collected regarding demographics, tumor type and location, and outcomes. Results Fifteen patients with intradural spinal metastases were investigated. The age range was 38-74 years (mean0 55 years; ±SD011.1). Predominant tumor location and type were lumbosacral and adenocarcinoma, respectively: 3 intramedullary and 12 extramedullary. Patients were operated on to relieve or prevent progressive/intractable neurological sequelae and/or pain. Of 13 who underwent resection, gross total removal was reported in 10; simple biopsy was performed in 2. There was one surgical complication, no medical complications, and no surgical mortality. At median follow-up of 1 month postoperatively, 10 of 15 patients were stable or improved. Of 13 patients who underwent resection, 10 were stable or improved. Of two patients who underwent biopsy, neither was stable or improved at follow-up. Using the Modified McCormick Scale, 11 of 15 patients were " functional" preoperatively and 4 went from "functional" preoperatively to "non-functional" postoperatively. Three of those four died within 60 days of surgery from systemic disease progression. Median hospital stay was 8 days. Ten of 15 patients died by the end of the study period, and the median survival of 15 patients was 5 months. Conclusions With improved outcomes in metastatic cancer, more patients are encountered in practice. An aggressive surgical approach is warranted for extramedullary lesions, whereas caution is advised for intramedullary lesions. Postoperative functional decline is more likely due to systemic disease progression rather than surgery.

AB - Background Intradural spinal metastases are rare, and little is known regarding surgical indications and outcomes. Methods A retrospective search identified adults with intradural spinal metastases operated on at the Mayo Clinic from 1994-2011. Data were collected regarding demographics, tumor type and location, and outcomes. Results Fifteen patients with intradural spinal metastases were investigated. The age range was 38-74 years (mean0 55 years; ±SD011.1). Predominant tumor location and type were lumbosacral and adenocarcinoma, respectively: 3 intramedullary and 12 extramedullary. Patients were operated on to relieve or prevent progressive/intractable neurological sequelae and/or pain. Of 13 who underwent resection, gross total removal was reported in 10; simple biopsy was performed in 2. There was one surgical complication, no medical complications, and no surgical mortality. At median follow-up of 1 month postoperatively, 10 of 15 patients were stable or improved. Of 13 patients who underwent resection, 10 were stable or improved. Of two patients who underwent biopsy, neither was stable or improved at follow-up. Using the Modified McCormick Scale, 11 of 15 patients were " functional" preoperatively and 4 went from "functional" preoperatively to "non-functional" postoperatively. Three of those four died within 60 days of surgery from systemic disease progression. Median hospital stay was 8 days. Ten of 15 patients died by the end of the study period, and the median survival of 15 patients was 5 months. Conclusions With improved outcomes in metastatic cancer, more patients are encountered in practice. An aggressive surgical approach is warranted for extramedullary lesions, whereas caution is advised for intramedullary lesions. Postoperative functional decline is more likely due to systemic disease progression rather than surgery.

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