Intraoperative radiotherapy combined with posterior decompression and stabilization for non-ambulant paralytic patients due to spinal metastasis.

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.