Operative therapy for skeletal metastases

Bone metastases of the vertebral spine occur frequently after breast cancer, hypernephroma or thyroid carcinoma. Located commonly in the lumbar and thoracic spine, half of the lesions are found in the vertebral body, but in many cases lamina and pedicles are also involved. Pain resistant to conservative treatment, vertebral compression fracture and segmental instability, together with progredient neurologic deficits and para- or tetraplegia, all make operative intervention mandatory. In this article dorsal decompression and stabilization are compared to ventral decompression and compound osteosynthesis. Segmental stability and life-time prognosis of the patient are important factors to decide on the best surgical procedure. Dorsal decompression without stabilization should only be performed as a palliative procedure in patients with an inoperative tumor, poor prognosis, or if the estimated postoperative segmental stability seems to be sufficient. In cases of a solitary metastasis, after radical resection of the primary tumor and when the prognosis is good total vertebrectomy can be performed. In addition to surgical treatment, adjuvant chemotherapy and/or radiation therapy should be performed in a multidisciplinary setting.