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  • Title: Intraoperative radiotherapy combined with posterior decompression and stabilization for non-ambulant paralytic patients due to spinal metastasis.
    Author: Kondo T, Hozumi T, Goto T, Seichi A, Nakamura K.
    Journal: Spine (Phila Pa 1976); 2008 Aug 01; 33(17):1898-904. PubMed ID: 18670344.
    Abstract:
    STUDY DESIGN: Retrospective examination of 96 nonambulant paralytic patients with spinal cord compression caused by metastatic cancer treated with intraoperative radiotherapy combined with conventional posterior surgery. OBJECTIVE: To improve local control of spinal metastasis by conducting posterior surgery combined with intraoperative radiotherapy (IORT) in patients with severe neurologic deficits. SUMMARY OF BACKGROUND DATA: Few studies of conventional posterior surgery demonstrated satisfactory neurologic recovery for nonambulant paralytic patients with advanced spinal metastases. METHODS: Ninety-six patients underwent IORT (107 procedures) for the treatment of severe spinal cord compression because of spinal metastases. All patients were nonambulatory before surgery. Eighty-three cases (86%) were in an advanced stage of multiple spinal metastases (types 6 or 7 of the surgical classification of vertebral tumors). After posterior decompression, a single large dose of electron beam irradiation was delivered to the exposed metastatic lesion while the spinal cord was protected using a lead shield. Posterior instrumentation was also performed for most patients. RESULTS: Ninety-five of 107 cases (89%) obtained at least one level of neurologic improvement according to Frankel's classification and 86 cases (80%) became ambulatory after surgery. The main factors related to a nonambulatory status after surgery were preoperative neurologic status, performance status, and the presence of internal organ metastases. Of 86 postoperative ambulatory cases, only 3 became nonambulatory because of local recurrence during the follow-up period. CONCLUSION: The IORT procedure is a useful technique for the treatment of spinal cord compression because of spinal metastasis, offering significant neurologic recovery and a low rate of local recurrence.
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