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Spinal Cord Compression Due to Epidural Malignancy Laminectomy: Does This Play any Role?

Arrotegui JI

Summary: The role of laminectomy in patients with malignant cord compression and vertebral collapse is by no means clear. It has become widely accepted that laminectomy is a potentially dangerous operation for patients with anterior vertebral collapse, resulting both in a greater likelihood of major neurological deterioration and an increased incidence of painful spinal instability.

Method: During the period 1989-1991 (N.G.H.) and 1986-1989 (K.I.), we observed 135 patients who underwent decompressive laminectomies for malignant epidural cord compression. Postoperatively, 68 patients could walk: 35 (51%) of the patients had no anterior vertebral collapse and 33 (49%) of them suffered anterior vertebral collapse. The presence of vertebral collapse did not appear to have an adverse effect on the outcome in these patients. Patients with lesions below T9 were significantly worse following laminectomy than those with lesions above T9.

Results: Decompressive laminectomy, may, therefore, still have a role in the management of patients with malignant spinal cord compression in the upper dorsal spine, despite vertebral collapse, particularly if other techniques, such as percutaneous needle biopsy, and anterior decompressive surgery are not available. Nevertheless, anterior decompression would clearly appear to be the first choice treatment.