Skip to main content
SpringerLink
Log in

Results of posterior surgery with intraoperative radiotherapy for spinal metastases

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Object: Spinal cord compression from spinal metastasis represents a substantial clinical problem. Complete resection of spinal metastases is difficult in many cases, and conventional surgical decompression of the spinal cord with or without instrumentation often results in unsatisfactory neurological recovery and local recurrence, even if combined with external radiotherapy. To increase rates of local control and improve neurological recovery in such cases, we introduced decompressive surgery combined with intraoperative radiotherapy (IORT) for the treatment of spinal metastasis in 1992. We report the results of neurological recovery and local control in cases that received surgery with IORT. Methods: Between November 1992 and December 2001, 133 cases (117 patients) were treated using IORT at Tokyo Metropolitan Komagome Hospital. The 79 cases (74 patients) that received posterior spine surgery only for spinal paresis due to spinal metastasis were reviewed. Results: Improvement of at least one level according to Frankel’s classification was attained in 68 cases (86%). Of the 58 patients unable to walk preoperatively, 45 patients (78%) regained walking ability postoperatively. Rate of local recurrence was 2.5%. Conclusions: IORT, combined with posterior surgery and FERT, might be one of the effective methods for local control of spinal metastasis and neurological improvement, especially in cases with progressive and multi-level lesions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Bauer HC (1997) Posterior decompression and stabilization for spinal metastases. Analysis of sixty-seven consecutive patients. J Bone Joint Surg Am 79:514–522

    PubMed  CAS  Google Scholar 

  2. Black P (1979) Spinal metastasis: current status and recommended guidelines for management. Neurosurgery 5:726–746

    Article  PubMed  CAS  Google Scholar 

  3. Eric JH (2000) Radiobiology for the radiologist, 5th edn. Lippincott Williams & Wilkins, Baltimore, pp 397–418

    Google Scholar 

  4. Frankel HL, Hancock DO, Hyslop G et al (1969) The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. Paraplegia 7:179–192

    PubMed  CAS  Google Scholar 

  5. Hatrick NC, Lucas JD, Timothy AR et al (2000) The surgical treatment of metastatic disease of the spine. Radiother Oncol Sep 56:335–339

    Article  CAS  Google Scholar 

  6. Jeremic B, Djuric L, Mijatovic L (1991) Incidence of radiation myelitis of the cervical spinal cord at doses of 5500 cGy or greater. Cancer 68:2138–2141

    Article  PubMed  CAS  Google Scholar 

  7. Manabe S, Tateishi A, Abe M et al (1989) Surgical treatment of metastatic tumors of the spine. Spine 14:41–47

    Article  PubMed  CAS  Google Scholar 

  8. Marcus RB, Million RR (1990) The incidence of myelitis after irradiation of the cervical spinal cord. Int J Radiat Oncol Biol Phys 19:3–8

    PubMed  Google Scholar 

  9. McCunniff A, Lliang MJ (1989) Radiation tolerance of the cervical spinal cord. Int J Radiat Oncol Biol Phys 16:675–678

    PubMed  CAS  Google Scholar 

  10. Missenard G, Lapresle P, Cote D (1996) Local control after surgical treatment of spinal metastatic disease. Eur Spine J 5:45–50

    Article  PubMed  CAS  Google Scholar 

  11. Nicholls PG, Jarecky TW (1985) Evaluate posterior decompression by laminectomy for malignant tumors of the spine. Clin Orthop 201:210

    PubMed  Google Scholar 

  12. Ortiz Gomez JA (1995) The incidence of vertebral body metastases. Int Orthop 19:309–311

    Article  PubMed  CAS  Google Scholar 

  13. Rompe JD, Hopf CG, Eysel P (1999) Outcome after palliative posterior surgery for metastatic disease of the spine—evaluation of 106 consecutive patients after decompression and stabilisation with the Cotrel-Dubousset instrumentation. Arch Orthop Trauma Surg 119:394–400

    Article  PubMed  CAS  Google Scholar 

  14. Sapkas G, Kyratzoulis J, Papaioannou N et al (1997) Spinal cord decompression and stabilization in malignant lesions of the spine. Acta Orthop Scand Suppl 275:97–100

    PubMed  CAS  Google Scholar 

  15. Schultheiss TE, Kun LE, Ang KK et al (1995) Radiation response of the central nervous system. Int J Radiat Oncol Biol Phys 31:1093–1112

    Article  PubMed  CAS  Google Scholar 

  16. Seichi A, Kondoh T, Hozumi T et al (1999) Intraoperative radiation therapy for metastatic spinal tumors. Spine 24:470–473

    Article  PubMed  CAS  Google Scholar 

  17. Tomita K, Kawahara N, Baba H et al (1997) Total en block spondylectomy. Spine 22:324–333

    Article  PubMed  CAS  Google Scholar 

  18. Wetzel FT, Phillips FM (2000) Management of metastatic disease of the spine. Orthop Clin North Am 31:611–621

    Article  PubMed  CAS  Google Scholar 

  19. Wong DA, Fornasier VL, MacNab I (1990) Spinal metastases: the obvious, the occult, and the impostors. Spine 15:1–4

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

The submitted manuscript does not contain any information regarding medical devices or drugs. No funds were received in support of this work and no benefits in any form have been or will be received from commercial parties related directly or indirectly to the subject of this manuscript.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Tokyo Metropolitan Komagome Hospital, 3-18-22 Hon-Komagome, Bunkyo-ku,, Tokyo, 113-6877, Japan

    Taku Saito, Taiji Kondo & Takahiro Hozumi

  2. Department of Radiation Oncology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan

    Katsuyuki Karasawa

  3. Department of Orthopaedic Surgery, University of Tokyo, Tokyo, Japan

    Atsushi Seichi & Kozo Nakamura

Authors
  1. Taku Saito
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Taiji Kondo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Takahiro Hozumi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Katsuyuki Karasawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Atsushi Seichi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kozo Nakamura
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Taku Saito.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Saito, T., Kondo, T., Hozumi, T. et al. Results of posterior surgery with intraoperative radiotherapy for spinal metastases. Eur Spine J 15, 216–222 (2006). https://doi.org/10.1007/s00586-005-0979-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-005-0979-2

Keywords

Search

Navigation