Surgical treatment of thoracic spinal tumours.

BACKGROUND AND PURPOSE: The aim of the study is to present the authors' experience with the treatment of metastatic tumours of the thoracic spine regarding surgical strategy depending on extent of neoplastic invasion. MATERIAL AND METHODS: Between January 2002 and August 2005, 15 patients with thoracic spinal tumours underwent surgical treatment with instrumental stabilization at the Department of Neurosurgery, Warsaw Medical School, Poland. Seven patients with tumours localized in vertebral bodies or vertebral bodies and pedicles were operated on via an anterior approach with concomitant stabilization at the same operative procedure. In 5 patients with metastatic involvement of vertebral arches and pedicles, a posterior approach for tumour removal was used with concomitant posterior fixation at the same operative procedure. Two patients with multiple spine metastases underwent internal fixation at the level corresponding to the observed symptoms. In 1 patient with bilateral lung cancer and vertebral body involvement, posterior stabilization with decompression of nervous structures was performed. RESULTS: None of the patients neurologically deteriorated after surgery. All patients with neurological deficits improved while one patient with pain syndrome did not. In 1 case approach-related surgical complications were observed. CONCLUSIONS: Regarding the complexity of surgical treatment of spinal metastases, the presented material is clearly not sufficient to draw firm conclusions. However, according to the authors' experience, the treatment of choice in single spinal metastasis involving the vertebral body is tumour removal via an anterior approach followed by adjunctive therapy. In metastatic lesions localized in vertebral pedicles and arches, removal via a posterior approach with concomitant posterior stabilization at the same operative procedure and adjunctive therapy is most indicated. Posterior stabilization of the spinal cord segment corresponding with symptoms is considered an appropriate surgical treatment of multiple spinal metastases.