16th German Spine Congress Annual Meeting of the German Spine Society 9th to 11th December 2021 Muenster, Germany

Background: Spinal metastases can lead to compression of the spinal cord through epidural tumor growth (ETG) and osseous destruction. In these cases, surgical therapy has been shown to be superior to radiation therapy. Till now, no gold standard exists regarding the choice of the operative procedure. Due to the increasing life expectancy, even with metastatic disease, bony fusion is also gaining in importance. In our clinic, we have been performing pVCR for decompression and stabilization in patients with ETG-related compression of the spinal cord and concomitant instability of the ventral column as well as a life expectancy of over 1 year. The aim of this study was to investigate the clinical and radiological outcome of the patients treated in this way. Method: All patients from 2013-2020 who were treated with pVCR for a tumor disease were included in a prospective database. Age, primary tumor, NRS, Frankel score, SINS, Karnofsky status (KPS) and radiological parameters were recorded from the HIS- system.
Results: 66 patients could be included. The mean follow-up was 39 days. At the time of the operation, the age was 64.4±10.9 years. The most common underlying diseases were multiple myelomas (n = breast cancer (n = 14), and lung cancer (n = 10). The SINS was The Epidural Spinal Cord Cmpression Score (ESCC) was The NRS (pre- 6.2±1.7 vs. postop 3.4±1.6) and segmental kyphosis (pre- ° vs. postop °) decreased significantly (p <0.001). The Frankel score worsened postoperatively in two (3%) patients, while an improvement was documented in 12 patients. The KPS remained constant during the observation period (preoperatively vs. follow-up Bony fusion was observed in 26 of 30 patients who received CT imaging more than 100 days after index surgery.
Conclusion: This study shows, that pVCR is a reliable surgical technique in patients with epidural tumor compression and cocomitant instability. It could be shown that the NRS was reduced in the short- and mid-term outcome, the KPS could be kept stable despite the seriously ill patients. The improvement in the Frankel score shows that the surgical objective can be reliably achieved. Despite the postoperative radiation, fusion rates of could be observed. We conclude that pVCR is a safe, fast and efficient strategy to achieve stability and pain relief in the long term in patients with epidural tumor compression.