Surgical management of vertebral neoplasia: who, when, how and why?

To determine the role of surgery in vertebral neoplasia, we conducted a retrospective review of patients undergoing surgery for vertebral neoplasia in the Royal Orthopaedic Hospital, Birmingham, and Coventry and Warwickshire Hospital, Coventry. Surgery included decompression, stabilisation or both. The neurological status was assessed by Frankel grading before and after surgery. Of 70 patients undergoing surgery, 14 were neurologically intact preoperatively, and a further 25 were weak but ambulatory. Following surgery, 35 were intact, and a further 22 were ambulatory. Sixty-six patients (94%) obtained good pain relief. Survival correlated with histology and younger age at presentation, but not with level, neurology at presentation or type of surgery. We conclude that neurological status, pain relief and mechanical stability are better after appropriate surgery than after radiotherapy or inappropriate surgery. Failure to consider the surgical option may deny the chance of significant neurological recovery.