[Surgical management of epidural spinal metastasis].

  From 1974 through 1983, 18 patients with metastatic epidural spinal tumors were admitted , and 12 cases were operated on, in order to relieve pain and neurological deficits . The age distribution of the 12 cases was between 4 and 74 years. Complete motor paralysis was seen in six cases , and in complete motor paralysis, in five cases. One showed no deficit except pain . Pain, either local or of radicular origin, was most common and present in 11 cases . Laminectomy and partial tumor removal were performed in six cases. Since 1981, more extensive excision of tumors and posterior fixation using Harrington rods or methylmethacrylate were performed on four cases . The remain ing two cases, with lesions in the cervical vertebral body, received vertebrectomy with fixation using methylmethacrylate in one, and autograft in the other . Postoperatively, pain relief was obtained in nine out of the 11 patients (82%). Among them two patients with extensive tumor removal and one with vertebrectomy became pain-free. Improvement of motor deficit was obtained in three of the five patients with incomplete paralysis treated by either laminectomy or extensive tumor removal , and in two of the six patients with complete paralysis, treated by the latter procedure . Among these five recovered patients four became ambulatory .   Our overall results suggest that extensive excision of metastatic lesion with either anterior or posterior fixation had better outcomes than simple decompressive laminectomy alone for pain relief and recovery from motor deficits.