Surgery Versus Radiation Therapy in Symptomatic Malignant Spinal Cord Compression
Keywords:Spinal cord compression, radiation therapy, surgical decompression, spinal metastases.
Malignant epidural spinal cord compression is an oncologic emergency that often results in pain and neurologic dysfunction, which may be permanent. Few prospective studies have been performed to determine whether surgical intervention confers a significant benefit over radiation therapy. We believe the small amount of existing evidence to support surgical intervention or radiation therapy alone suffers from patient selection bias, and that such bias tends to bear out in practice as well. In addition to the objective benefits achieved by surgical decompression, practitioners need to consider the subjective benefits such as increased ambulatory ability, increased spine stability, and improved pain management provided by timely surgical decompression of metastatic spinal cord lesions.
Chi JH, Gokaslan Z, McCormick P, Tibbs PA, Kryscio RJ, Patchell RA. Selecting treatment for patients with malignant epidural spinal cord compression-does age matter?: results from a randomized clinical trial. Spine (Phila Pa 1976) 2009; 34: 431-5.
Young RF, Post EM, King GA. Treatment of spinal epidural metastases. Randomized prospective comparison of laminectomy and radiotherapy. J Neurosurg 1980; 53: 741-8. http://dx.doi.org/10.3171/jns.1980.53.6.0741
Findlay GF. Adverse effects of the management of malignant spinal cord compression. J Neurol Neurosurg Psychiatry 1984; 47: 761-8. http://dx.doi.org/10.1136/jnnp.47.8.761
Tabbara IA, Sibley DS, Quesenberry PJ. Spinal cord compression due to metastatic neoplasm. South Med J 1990; 83: 519-23. http://dx.doi.org/10.1097/00007611-199005000-00010
Klimo P, Jr., Thompson CJ, Kestle JR, Schmidt MH. A meta-analysis of surgery versus conventional radiotherapy for the treatment of metastatic spinal epidural disease. Neuro Oncol 2005; 7: 64-76. http://dx.doi.org/10.1215/S1152851704000262
Patchell RA, Tibbs PA, Regine WF, et al. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet 2005; 366: 643-8. http://dx.doi.org/10.1016/S0140-6736(05)66954-1
Rades D, Huttenlocher S, Dunst J, et al. Matched pair analysis comparing surgery followed by radiotherapy and radiotherapy alone for metastatic spinal cord compression. J Clin Oncol 2010; 28: 3597-604. http://dx.doi.org/10.1200/JCO.2010.28.5635
George R, Jeba J, Ramkumar G, Chacko AG, Leng M, Tharyan P. Interventions for the treatment of metastatic extradural spinal cord compression in adults. Cochrane Database Syst Rev 2008; CD006716.
Wai EK, Finkelstein JA, Tangente RP, et al. Quality of life in surgical treatment of metastatic spine disease. Spine (Phila Pa 1976) 2003; 28:508-12.
Dunning EC, Butler JS, Morris S. Complications in the management of metastatic spinal disease. World J Orthop 2012; 3: 114-21. http://dx.doi.org/10.5312/wjo.v3.i8.114
White AP, Kwon BK, Lindskog DM, Friedlaender GE, Grauer JN. Metastatic disease of the spine. J Am Acad Orthop Surg 2006; 14: 587-98.
Quraishi NA, Gokaslan ZL, Boriani S. The surgical management of metastatic epidural compression of the spinal cord. J Bone Joint Surg Br 2010; 92: 1054-60. http://dx.doi.org/10.1302/0301-620X.92B8.22296
Bilsky MH, Lis E, Raizer J, Lee H, Boland P. The diagnosis and treatment of metastatic spinal tumor. Oncologist 1999; 4: 459-69.
Walter J, Reichart R, Waschke A, Kalff R, Ewald C. Palliative considerations in the surgical treatment of spinal metastases: evaluation of posterolateral decompression combined with posterior instrumentation. J Cancer Res Clin Oncol 2012; 138: 301-10. http://dx.doi.org/10.1007/s00432-011-1100-3